Provider Demographics
NPI:1760684310
Name:RIVERSIDE HEALTH CLINIC, P.C.
Entity Type:Organization
Organization Name:RIVERSIDE HEALTH CLINIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AMISH
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:847-922-8410
Mailing Address - Street 1:960 RAND RD
Mailing Address - Street 2:SUITE 212
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-2352
Mailing Address - Country:US
Mailing Address - Phone:847-922-8410
Mailing Address - Fax:847-824-6879
Practice Address - Street 1:960 RAND RD
Practice Address - Street 2:SUITE 212
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60016-2352
Practice Address - Country:US
Practice Address - Phone:847-922-8410
Practice Address - Fax:847-824-6879
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-05
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-008850111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL997120Medicare PIN