Provider Demographics
NPI:1336384254
Name:BHF-BOULEVARD HEALTH FACILITIES
Entity Type:Organization
Organization Name:BHF-BOULEVARD HEALTH FACILITIES
Other - Org Name:BOULEVARD HEALTH FACILITY
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALFRED
Authorized Official - Middle Name:F
Authorized Official - Last Name:LARCHER D.C.
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:773-736-1383
Mailing Address - Street 1:7039 W. ADDISON ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60634
Mailing Address - Country:US
Mailing Address - Phone:773-736-1383
Mailing Address - Fax:773-736-1383
Practice Address - Street 1:7039 W. ADDISON ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60634
Practice Address - Country:US
Practice Address - Phone:773-736-1383
Practice Address - Fax:773-736-1389
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BHF-BOULEVARD HEALTH FACILITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-12-05
Last Update Date:2008-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-003392111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty