Provider Demographics
NPI:1255638680
Name:HIGHLAND PARK CHIROPRACTIC, SC
Entity type:Organization
Organization Name:HIGHLAND PARK CHIROPRACTIC, SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:GOODMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:561-213-7666
Mailing Address - Street 1:1 E DELAWARE PL
Mailing Address - Street 2:SUITE 302
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-1449
Mailing Address - Country:US
Mailing Address - Phone:312-543-4492
Mailing Address - Fax:312-337-4060
Practice Address - Street 1:600 CENTRAL AVE
Practice Address - Street 2:SUITE 144
Practice Address - City:HIGHLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60035-3211
Practice Address - Country:US
Practice Address - Phone:312-337-4004
Practice Address - Fax:312-337-4060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-21
Last Update Date:2011-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-007969111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty