Provider Demographics
NPI:1972726438
Name:AVANZADO QUIROPRACTICO SC
Entity Type:Organization
Organization Name:AVANZADO QUIROPRACTICO SC
Other - Org Name:CAWLEY CHIROPRACTIC CARE PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:CAWLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:773-426-2264
Mailing Address - Street 1:646 W WELLINGTON AVE
Mailing Address - Street 2:SUITE # 2E
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-9329
Mailing Address - Country:US
Mailing Address - Phone:773-426-2264
Mailing Address - Fax:
Practice Address - Street 1:646 W WELLINGTON AVE
Practice Address - Street 2:SUITE # 2E
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-9329
Practice Address - Country:US
Practice Address - Phone:773-426-2264
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2011-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038009827111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01635106OtherBLUE CROSS AND BLUE SHIELD
IL211450Medicare PIN
IL01635106OtherBLUE CROSS AND BLUE SHIELD