Provider Demographics
NPI: | 1780225953 |
---|---|
Name: | CHICAGO HEADACHE CENTER AND RESEARCH INSTITUTE LLC |
Entity Type: | Organization |
Organization Name: | CHICAGO HEADACHE CENTER AND RESEARCH INSTITUTE LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OWNER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | BRADLEY |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | TORPHY |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MD |
Authorized Official - Phone: | 773-935-1000 |
Mailing Address - Street 1: | 3000 N HALSTED ST STE 601 |
Mailing Address - Street 2: | |
Mailing Address - City: | CHICAGO |
Mailing Address - State: | IL |
Mailing Address - Zip Code: | 60657-9269 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 773-935-1000 |
Mailing Address - Fax: | 773-935-1000 |
Practice Address - Street 1: | 3000 N HALSTED ST STE 711 |
Practice Address - Street 2: | |
Practice Address - City: | CHICAGO |
Practice Address - State: | IL |
Practice Address - Zip Code: | 60657-6185 |
Practice Address - Country: | US |
Practice Address - Phone: | 773-935-1000 |
Practice Address - Fax: | 773-938-0500 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2019-09-30 |
Last Update Date: | 2023-09-06 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty |