Provider Demographics
NPI:1740210400
Name:COMMUNITY CHIROPRACTIC, INC.
Entity Type:Organization
Organization Name:COMMUNITY CHIROPRACTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:MAJ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:773-528-8485
Mailing Address - Street 1:1442 W. BELMONT AVE.
Mailing Address - Street 2:SUITE 1E
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-3204
Mailing Address - Country:US
Mailing Address - Phone:773-528-8485
Mailing Address - Fax:
Practice Address - Street 1:1442 W BELMONT AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-9422
Practice Address - Country:US
Practice Address - Phone:773-528-8485
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2013-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-007640111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty