Provider Demographics
NPI:1790873677
Name:CHIROPRACTIC CARE LTD
Entity Type:Organization
Organization Name:CHIROPRACTIC CARE LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:ANDERSEN
Authorized Official - Last Name:KRUSE
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:708-798-5556
Mailing Address - Street 1:2417 W 183RD STREET
Mailing Address - Street 2:
Mailing Address - City:HOMEWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60430
Mailing Address - Country:US
Mailing Address - Phone:708-798-5556
Mailing Address - Fax:708-798-5550
Practice Address - Street 1:2417 W 183RD STREET
Practice Address - Street 2:
Practice Address - City:HOMEWOOD
Practice Address - State:IL
Practice Address - Zip Code:60430
Practice Address - Country:US
Practice Address - Phone:708-798-5556
Practice Address - Fax:708-798-5550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
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
201582Medicare ID - Type Unspecified
U19761Medicare UPIN