Provider Demographics
NPI:1659551943
Name:COLEMAN CHIROPRACTIC CENTER, LTD.
Entity Type:Organization
Organization Name:COLEMAN CHIROPRACTIC CENTER, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:COLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:630-553-7600
Mailing Address - Street 1:1308 SUNSET AVE
Mailing Address - Street 2:
Mailing Address - City:YORKVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60560-1173
Mailing Address - Country:US
Mailing Address - Phone:630-553-7600
Mailing Address - Fax:630-553-1306
Practice Address - Street 1:1308 SUNSET AVE
Practice Address - Street 2:
Practice Address - City:YORKVILLE
Practice Address - State:IL
Practice Address - Zip Code:60560-1173
Practice Address - Country:US
Practice Address - Phone:630-553-7600
Practice Address - Fax:630-553-1306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-05
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center