Provider Demographics
NPI:1396927588
Name:LEMONT CHIROPRACTIC CENTER PC
Entity type:Organization
Organization Name:LEMONT CHIROPRACTIC CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:MICHALOWSLI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:630-257-9132
Mailing Address - Street 1:15337 E 127TH ST
Mailing Address - Street 2:
Mailing Address - City:LEMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60439-7412
Mailing Address - Country:US
Mailing Address - Phone:630-257-9132
Mailing Address - Fax:630-257-9136
Practice Address - Street 1:15337 E 127TH ST
Practice Address - Street 2:
Practice Address - City:LEMONT
Practice Address - State:IL
Practice Address - Zip Code:60439-7412
Practice Address - Country:US
Practice Address - Phone:630-257-9132
Practice Address - Fax:630-257-9136
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-29
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038005266111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1682603OtherBLUE CROSS BLUE SHIELD
IL1682603OtherBLUE CROSS BLUE SHIELD