Provider Demographics
NPI:1790905420
Name:BACK TO LIFE, P.C. OF IL
Entity Type:Organization
Organization Name:BACK TO LIFE, P.C. OF IL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER,
Authorized Official - Prefix:DR
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:EMLEN
Authorized Official - Last Name:JENKINS-COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:773-721-3000
Mailing Address - Street 1:1401 E 87TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60619-6522
Mailing Address - Country:US
Mailing Address - Phone:773-721-3000
Mailing Address - Fax:
Practice Address - Street 1:1401 E 87TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60619-6522
Practice Address - Country:US
Practice Address - Phone:773-721-3000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
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