Provider Demographics
NPI:1689728701
Name:BOURDAGE CHIROPRACTIC, SC
Entity Type:Organization
Organization Name:BOURDAGE CHIROPRACTIC, SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:BOURDAGE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:773-545-9379
Mailing Address - Street 1:6443 N CICERO AVE
Mailing Address - Street 2:
Mailing Address - City:LINCOLNWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60712-3407
Mailing Address - Country:US
Mailing Address - Phone:773-545-9379
Mailing Address - Fax:773-545-9372
Practice Address - Street 1:6443 N CICERO AVE
Practice Address - Street 2:
Practice Address - City:LINCOLNWOOD
Practice Address - State:IL
Practice Address - Zip Code:60712-3407
Practice Address - Country:US
Practice Address - Phone:773-545-9379
Practice Address - Fax:773-545-9372
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-010680111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty