Provider Demographics
NPI:1851631154
Name:AFFINITY CHIROPRACTIC AND REHABILITATION, LLC
Entity Type:Organization
Organization Name:AFFINITY CHIROPRACTIC AND REHABILITATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TAMIKO
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:LIBURD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-885-0378
Mailing Address - Street 1:1518 E 63RD ST.
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60637-2921
Mailing Address - Country:US
Mailing Address - Phone:312-225-1100
Mailing Address - Fax:773-363-7822
Practice Address - Street 1:1518 E. 63RD ST.
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60637-2921
Practice Address - Country:US
Practice Address - Phone:773-241-6600
Practice Address - Fax:773-363-7822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-22
Last Update Date:2015-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.012205111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL8242Medicare UPIN