Provider Demographics
NPI:1760502108
Name:WEST LOOP CHIROPRACTIC
Entity Type:Organization
Organization Name:WEST LOOP CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ASHER
Authorized Official - Last Name:ROSEN
Authorized Official - Suffix:SR
Authorized Official - Credentials:DC
Authorized Official - Phone:312-850-2225
Mailing Address - Street 1:1000 W WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-2137
Mailing Address - Country:US
Mailing Address - Phone:312-850-2225
Mailing Address - Fax:
Practice Address - Street 1:1000 W WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-2137
Practice Address - Country:US
Practice Address - Phone:312-850-2225
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01633124OtherBCBS
IL205021Medicare PIN