Provider Demographics
NPI:1851593271
Name:CUSANO CHIROPRACTIC
Entity Type:Organization
Organization Name:CUSANO CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOROWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DOMENIC
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:CUSANO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:773-631-0660
Mailing Address - Street 1:6580 N NORTHWEST HWY
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60631-1415
Mailing Address - Country:US
Mailing Address - Phone:773-631-0660
Mailing Address - Fax:773-631-1869
Practice Address - Street 1:6580 N NORTHWEST HWY
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60631-1415
Practice Address - Country:US
Practice Address - Phone:773-631-0660
Practice Address - Fax:773-631-1869
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-05
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
1083625545OtherINDIVIDUAL NPI NUMBER
IL1682289OtherBCBS PROVIDER NUMBER
1083625545OtherINDIVIDUAL NPI NUMBER