Provider Demographics
NPI:1740309343
Name:FAMILY CHIROPRACTIC
Entity type:Organization
Organization Name:FAMILY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:WELCH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:847-742-5200
Mailing Address - Street 1:329 RANDALL RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60177-2248
Mailing Address - Country:US
Mailing Address - Phone:847-742-5200
Mailing Address - Fax:847-742-5052
Practice Address - Street 1:329 RANDALL RD
Practice Address - Street 2:
Practice Address - City:SOUTH ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60177-2248
Practice Address - Country:US
Practice Address - Phone:847-742-5200
Practice Address - Fax:847-742-5052
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILT39182Medicare UPIN
IL792790Medicare ID - Type UnspecifiedDR. WELCH PROVIDER NUMBER
ILT38521Medicare UPIN
IL201599Medicare ID - Type UnspecifiedDR. GOETZ PROVIDER NUMBER