Provider Demographics
NPI:1972727378
Name:LOOP CHIROPRACTIC & SPORTS INJURY CENTER, LTD.
Entity Type:Organization
Organization Name:LOOP CHIROPRACTIC & SPORTS INJURY CENTER, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALDEN
Authorized Official - Middle Name:C
Authorized Official - Last Name:CLENDENIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:312-236-9355
Mailing Address - Street 1:39 S. LASALLE STREET
Mailing Address - Street 2:#617
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60603
Mailing Address - Country:US
Mailing Address - Phone:312-236-9355
Mailing Address - Fax:773-236-9301
Practice Address - Street 1:39 S. LASALLE STREET
Practice Address - Street 2:#617
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60603
Practice Address - Country:US
Practice Address - Phone:312-236-9355
Practice Address - Fax:773-236-9301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2012-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-010201111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty