Provider Demographics
NPI:1871031476
Name:PRESTIGE CHIROPRACTIC INCORPORATED
Entity Type:Organization
Organization Name:PRESTIGE CHIROPRACTIC INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHERMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CLAY
Authorized Official - Suffix:II
Authorized Official - Credentials:DC
Authorized Official - Phone:773-324-4325
Mailing Address - Street 1:7141 S JEFFERY BLVD
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60649-2425
Mailing Address - Country:US
Mailing Address - Phone:773-324-4325
Mailing Address - Fax:773-324-4324
Practice Address - Street 1:7141 S JEFFERY BLVD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60649-2425
Practice Address - Country:US
Practice Address - Phone:773-324-4325
Practice Address - Fax:773-324-4324
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-03
Last Update Date:2017-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.011791111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty