Provider Demographics
NPI:1629155114
Name:CHIROPRACTIC CENTRE OF HIGHLAND PARK, INC
Entity Type:Organization
Organization Name:CHIROPRACTIC CENTRE OF HIGHLAND PARK, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:MCNULTY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:847-831-5252
Mailing Address - Street 1:210 SKOKIE VALLEY RD
Mailing Address - Street 2:SUITE 7
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035-4464
Mailing Address - Country:US
Mailing Address - Phone:847-831-5252
Mailing Address - Fax:847-831-5272
Practice Address - Street 1:210 SKOKIE VALLEY RD
Practice Address - Street 2:SUITE 7
Practice Address - City:HIGHLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60035-4464
Practice Address - Country:US
Practice Address - Phone:847-831-5252
Practice Address - Fax:847-831-5272
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty