Provider Demographics
NPI:1356547939
Name:PINS FAMILY CHIROPRACTIC
Entity type:Organization
Organization Name:PINS FAMILY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:PINS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:630-527-9100
Mailing Address - Street 1:1250 S NAPER BLVD
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-8312
Mailing Address - Country:US
Mailing Address - Phone:630-527-9100
Mailing Address - Fax:630-527-9129
Practice Address - Street 1:1250 S NAPER BLVD
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-8312
Practice Address - Country:US
Practice Address - Phone:630-527-9100
Practice Address - Fax:630-527-9129
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-21
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038008344111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL04526037Medicaid
IL038008344Medicaid
IL038008344Medicaid
IL04526037Medicaid