Provider Demographics
NPI:1831301522
Name:CHICAGO CHIROPRACTIC & SPORTS INJURY CENTER
Entity Type:Organization
Organization Name:CHICAGO CHIROPRACTIC & SPORTS INJURY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ALDEN
Authorized Official - Middle Name:C
Authorized Official - Last Name:CLENDENIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:773-529-5670
Mailing Address - Street 1:2654 N LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-1307
Mailing Address - Country:US
Mailing Address - Phone:773-529-5670
Mailing Address - Fax:773-529-5672
Practice Address - Street 1:2654 N LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-1307
Practice Address - Country:US
Practice Address - Phone:773-529-5670
Practice Address - Fax:773-529-5672
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILU75196Medicare UPIN
IL543420Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER