Provider Demographics
NPI:1659603009
Name:ALLIANCE OF CHICAGO THERAPEUTIC SERVICES AND SUPPLIES
Entity Type:Organization
Organization Name:ALLIANCE OF CHICAGO THERAPEUTIC SERVICES AND SUPPLIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CARTER
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-425-7977
Mailing Address - Street 1:2800 W PETERSON AVE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60659-3816
Mailing Address - Country:US
Mailing Address - Phone:773-661-4499
Mailing Address - Fax:773-290-1344
Practice Address - Street 1:2800 W PETERSON AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60659-3816
Practice Address - Country:US
Practice Address - Phone:773-661-4499
Practice Address - Fax:773-290-1344
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-10
Last Update Date:2010-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies