Provider Demographics
NPI:1912366634
Name:OPPORTUNITY CHIROPRACTIC, INC.
Entity Type:Organization
Organization Name:OPPORTUNITY CHIROPRACTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LORETO
Authorized Official - Middle Name:
Authorized Official - Last Name:LO BOSCO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:847-305-1343
Mailing Address - Street 1:355 W DUNDEE RD STE 110
Mailing Address - Street 2:
Mailing Address - City:BUFFALO GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60089-3500
Mailing Address - Country:US
Mailing Address - Phone:847-305-1343
Mailing Address - Fax:
Practice Address - Street 1:355 W DUNDEE RD STE 110
Practice Address - Street 2:
Practice Address - City:BUFFALO GROVE
Practice Address - State:IL
Practice Address - Zip Code:60089-3500
Practice Address - Country:US
Practice Address - Phone:847-305-1343
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-23
Last Update Date:2016-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038012359111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty