Provider Demographics
NPI:1629297486
Name:CHISLOF CHIROPRACTIC CENTER, P.C.
Entity Type:Organization
Organization Name:CHISLOF CHIROPRACTIC CENTER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:IRA
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:CHISLOF
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:847-588-0800
Mailing Address - Street 1:7329 N HARLEM AVE
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:IL
Mailing Address - Zip Code:60714-4252
Mailing Address - Country:US
Mailing Address - Phone:847-588-0800
Mailing Address - Fax:847-588-0811
Practice Address - Street 1:7329 N HARLEM AVE
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:IL
Practice Address - Zip Code:60714-4252
Practice Address - Country:US
Practice Address - Phone:847-588-0800
Practice Address - Fax:847-588-0811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038004506261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL680870Medicare ID - Type Unspecified