Provider Demographics
NPI:1649460270
Name:CHIROPRACTIC AND ACUPUNCTURE CENTER INC
Entity type:Organization
Organization Name:CHIROPRACTIC AND ACUPUNCTURE CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-635-8080
Mailing Address - Street 1:2604 DEMPSTER ST
Mailing Address - Street 2:SUITE 304
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-8412
Mailing Address - Country:US
Mailing Address - Phone:847-635-8080
Mailing Address - Fax:847-390-8080
Practice Address - Street 1:2604 DEMPSTER ST
Practice Address - Street 2:SUITE 304
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-8412
Practice Address - Country:US
Practice Address - Phone:847-635-8080
Practice Address - Fax:847-390-8080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-30
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-005366111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL131172OtherACN
IL016-36062OtherBLUE CROSS/BLUE SHIELD
IL131172OtherACN
IL016-36062OtherBLUE CROSS/BLUE SHIELD