Provider Demographics
NPI:1982823266
Name:ADVANTAGE CHIROPRACTIC AND REHABILITATION, SC
Entity Type:Organization
Organization Name:ADVANTAGE CHIROPRACTIC AND REHABILITATION, SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:CLAYTON
Authorized Official - Last Name:SHROBA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:708-425-0770
Mailing Address - Street 1:4809 W 95TH ST
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-2501
Mailing Address - Country:US
Mailing Address - Phone:708-425-0770
Mailing Address - Fax:708-425-0880
Practice Address - Street 1:4809 W 95TH ST
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-2501
Practice Address - Country:US
Practice Address - Phone:708-425-0770
Practice Address - Fax:708-425-0880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL206493Medicare ID - Type Unspecified
ILU 96131Medicare UPIN