Provider Demographics
NPI:1295089712
Name:LAGRANGE INSTITUTE OF HEALTH LTD
Entity type:Organization
Organization Name:LAGRANGE INSTITUTE OF HEALTH LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:GINA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:SIRCHIO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:312-255-8810
Mailing Address - Street 1:430 W ERIE ST
Mailing Address - Street 2:SUITE 403
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60654-6914
Mailing Address - Country:US
Mailing Address - Phone:312-255-8810
Mailing Address - Fax:312-846-6817
Practice Address - Street 1:430 W ERIE ST
Practice Address - Street 2:SUITE 403
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60654-6914
Practice Address - Country:US
Practice Address - Phone:312-255-8810
Practice Address - Fax:312-846-6817
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-06
Last Update Date:2015-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038010610111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN1001XChiropractic ProvidersChiropractorNutritionGroup - Multi-Specialty