Provider Demographics
NPI:1245456029
Name:MIND BODY HEALTHCARE LLC
Entity type:Organization
Organization Name:MIND BODY HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:HARPAL
Authorized Official - Middle Name:SINGH
Authorized Official - Last Name:GILL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:773-267-2675
Mailing Address - Street 1:3839 N WESTERN AVE
Mailing Address - Street 2:SUITE 1B
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-3733
Mailing Address - Country:US
Mailing Address - Phone:773-267-2675
Mailing Address - Fax:
Practice Address - Street 1:3839 N WESTERN AVE
Practice Address - Street 2:SUITE 1B
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-3733
Practice Address - Country:US
Practice Address - Phone:773-267-2675
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01634775OtherBCBS OF ILLINOIS PROVIDER
IL=========-0002OtherUNITED HEALTHCARE
IL01634775OtherBCBS OF ILLINOIS PROVIDER
IL01634775OtherBCBS OF ILLINOIS PROVIDER