Provider Demographics
NPI:1669563623
Name:CHANCELLOR CHIROPRACTIC, LTD.
Entity type:Organization
Organization Name:CHANCELLOR CHIROPRACTIC, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:CHANCELLOR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:708-482-3443
Mailing Address - Street 1:633 S LA GRANGE RD
Mailing Address - Street 2:11
Mailing Address - City:LA GRANGE
Mailing Address - State:IL
Mailing Address - Zip Code:60525-6741
Mailing Address - Country:US
Mailing Address - Phone:708-482-3443
Mailing Address - Fax:708-482-3444
Practice Address - Street 1:633 S LA GRANGE RD
Practice Address - Street 2:11
Practice Address - City:LA GRANGE
Practice Address - State:IL
Practice Address - Zip Code:60525-6741
Practice Address - Country:US
Practice Address - Phone:708-482-3443
Practice Address - Fax:708-482-3444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty