Provider Demographics
NPI:1942774534
Name:OAK STREET CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:OAK STREET CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:HASKELL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:618-382-4834
Mailing Address - Street 1:908 OAK ST
Mailing Address - Street 2:
Mailing Address - City:CARMI
Mailing Address - State:IL
Mailing Address - Zip Code:62821-1340
Mailing Address - Country:US
Mailing Address - Phone:618-382-4834
Mailing Address - Fax:618-382-7129
Practice Address - Street 1:908 OAK ST
Practice Address - Street 2:
Practice Address - City:CARMI
Practice Address - State:IL
Practice Address - Zip Code:62821-1340
Practice Address - Country:US
Practice Address - Phone:618-382-4834
Practice Address - Fax:618-382-7129
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-16
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty