Provider Demographics
NPI:1255634234
Name:CHICAGO FAMILY CHIROPRACTIC CARE
Entity type:Organization
Organization Name:CHICAGO FAMILY CHIROPRACTIC CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:L
Authorized Official - Last Name:DONAHUE
Authorized Official - Suffix:III
Authorized Official - Credentials:DC, CCSP
Authorized Official - Phone:773-697-0176
Mailing Address - Street 1:922 W DIVERSEY PKWY
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-1416
Mailing Address - Country:US
Mailing Address - Phone:773-697-0176
Mailing Address - Fax:773-529-0231
Practice Address - Street 1:922 W DIVERSEY PKWY
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-1416
Practice Address - Country:US
Practice Address - Phone:773-697-0176
Practice Address - Fax:773-529-0231
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-13
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.009384305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1780692988OtherNPI 1
IL703750OtherMEDICARE
IL=========OtherTAX ID