Provider Demographics
NPI:1255367876
Name:CHICAGO SPORTS AND CHIROPRACTIC MEDICINE, SC
Entity type:Organization
Organization Name:CHICAGO SPORTS AND CHIROPRACTIC MEDICINE, SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER-PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DARREN
Authorized Official - Middle Name:D
Authorized Official - Last Name:HANCOCK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:773-736-1181
Mailing Address - Street 1:3546 N NORA AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60634-3617
Mailing Address - Country:US
Mailing Address - Phone:773-736-1811
Mailing Address - Fax:773-736-1185
Practice Address - Street 1:3546 N NORA AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60634-3617
Practice Address - Country:US
Practice Address - Phone:773-736-1181
Practice Address - Fax:773-736-1185
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-24
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL042-618469111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty