Provider Demographics
NPI:1790806289
Name:OAK BROOK CHIROPRACTIC CENTER PC
Entity Type:Organization
Organization Name:OAK BROOK CHIROPRACTIC CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:E
Authorized Official - Last Name:CLAUSSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:630-990-7246
Mailing Address - Street 1:1000 JORIE BLVD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523
Mailing Address - Country:US
Mailing Address - Phone:630-990-7246
Mailing Address - Fax:630-990-7417
Practice Address - Street 1:1000 JORIE BLVD
Practice Address - Street 2:SUITE 120
Practice Address - City:OAK BROOK
Practice Address - State:IL
Practice Address - Zip Code:60523
Practice Address - Country:US
Practice Address - Phone:630-990-7246
Practice Address - Fax:630-990-7417
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL885647OtherUNITED HEALTHCARE
IL02222028OtherBCBS
IL02222028OtherBCBS
728210Medicare ID - Type Unspecified