Provider Demographics
NPI:1942428644
Name:ALLIANCE CHIROPRACTIC HEALTH CENTER INC
Entity Type:Organization
Organization Name:ALLIANCE CHIROPRACTIC HEALTH CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VIRGILIO
Authorized Official - Middle Name:C
Authorized Official - Last Name:CASTILLO
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:773-878-2660
Mailing Address - Street 1:4539 N WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-2116
Mailing Address - Country:US
Mailing Address - Phone:773-878-2660
Mailing Address - Fax:773-878-2860
Practice Address - Street 1:4539 N WESTERN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-2116
Practice Address - Country:US
Practice Address - Phone:773-878-2660
Practice Address - Fax:773-878-2860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-20
Last Update Date:2011-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-009043111N00000X
IL038008973111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01630039OtherBCBS CASTILLO & REYES
ILU87385Medicare UPIN
IL01630039OtherBCBS CASTILLO & REYES
ILL88711Medicare ID - Type UnspecifiedCASTILLO
ILL88712Medicare ID - Type UnspecifiedREYES