Provider Demographics
NPI:1295913572
Name:VANDERBILT FAMILY CHIROPRACTIC, LLC
Entity type:Organization
Organization Name:VANDERBILT FAMILY CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:VANDERBILT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:847-719-2225
Mailing Address - Street 1:40 LANDOVER PKWY
Mailing Address - Street 2:SUITE 2
Mailing Address - City:HAWTHORN WOODS
Mailing Address - State:IL
Mailing Address - Zip Code:60047-7508
Mailing Address - Country:US
Mailing Address - Phone:847-719-2225
Mailing Address - Fax:847-719-2527
Practice Address - Street 1:40 LANDOVER PKWY
Practice Address - Street 2:SUITE 2
Practice Address - City:HAWTHORN WOODS
Practice Address - State:IL
Practice Address - Zip Code:60047-7508
Practice Address - Country:US
Practice Address - Phone:847-719-2225
Practice Address - Fax:847-719-2527
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-08
Last Update Date:2008-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK10918OtherMEDICARE MEMBER NUMBER
ILK10918OtherMEDICARE MEMBER NUMBER
IL210044Medicare PIN