Provider Demographics
NPI:1730308487
Name:A.G. FAMILY CHIROPRACTIC, SC
Entity Type:Organization
Organization Name:A.G. FAMILY CHIROPRACTIC, SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:VINCENT
Authorized Official - Last Name:GIOIA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:847-854-0505
Mailing Address - Street 1:1303 W ALGONQUIN RD
Mailing Address - Street 2:
Mailing Address - City:LAKE IN THE HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60156-3575
Mailing Address - Country:US
Mailing Address - Phone:847-854-0505
Mailing Address - Fax:847-854-0808
Practice Address - Street 1:1303 W ALGONQUIN RD
Practice Address - Street 2:
Practice Address - City:LAKE IN THE HILLS
Practice Address - State:IL
Practice Address - Zip Code:60156-3575
Practice Address - Country:US
Practice Address - Phone:847-854-0505
Practice Address - Fax:847-854-0808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2013-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-007214111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILU46349Medicare UPIN
IL334870Medicare ID - Type Unspecified