Provider Demographics
NPI:1720152168
Name:CECIL CHIROPRACTIC CLINIC, P.C.
Entity Type:Organization
Organization Name:CECIL CHIROPRACTIC CLINIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:ALLAN
Authorized Official - Last Name:CECIL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-352-9393
Mailing Address - Street 1:4601 WOODWARD AVE
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-2632
Mailing Address - Country:US
Mailing Address - Phone:630-964-5117
Mailing Address - Fax:708-352-5077
Practice Address - Street 1:917C W 55TH ST
Practice Address - Street 2:
Practice Address - City:COUNTRYSIDE
Practice Address - State:IL
Practice Address - Zip Code:60525-6613
Practice Address - Country:US
Practice Address - Phone:708-352-9393
Practice Address - Fax:708-352-5077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-18
Last Update Date:2020-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL16-82743OtherBLUECROSSBLUESHIELD
IL16-82743OtherBLUECROSSBLUESHIELD
ILT38887Medicare UPIN