Provider Demographics
NPI:1205059912
Name:LINCOLN PARK CHIROPRACTIC, PC
Entity type:Organization
Organization Name:LINCOLN PARK CHIROPRACTIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:F
Authorized Official - Last Name:ZID
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:773-248-2790
Mailing Address - Street 1:2202 N LINCOLN AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-7170
Mailing Address - Country:US
Mailing Address - Phone:773-248-2790
Mailing Address - Fax:773-248-2058
Practice Address - Street 1:2202 N LINCOLN AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-7170
Practice Address - Country:US
Practice Address - Phone:773-248-2790
Practice Address - Fax:773-248-2058
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2010-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL38-007442111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty