Provider Demographics
NPI:1811188816
Name:COMPLETE CHIROPRACTIC CARE PC
Entity Type:Organization
Organization Name:COMPLETE CHIROPRACTIC CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:OLGA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSHIOR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:630-460-6733
Mailing Address - Street 1:1749 S NAPERVILLE RD
Mailing Address - Street 2:STE 207
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-8192
Mailing Address - Country:US
Mailing Address - Phone:630-460-6733
Mailing Address - Fax:630-752-1222
Practice Address - Street 1:1749 S NAPERVILLE RD
Practice Address - Street 2:STE 207
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-8192
Practice Address - Country:US
Practice Address - Phone:630-460-6733
Practice Address - Fax:630-752-1222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-05
Last Update Date:2007-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL02232306OtherBCBS
IL1558496802OtherINDIVIDUAL NPI
IL02232306OtherBCBS