Provider Demographics
NPI:1811180813
Name:CHIROSOURCE, LTD.
Entity type:Organization
Organization Name:CHIROSOURCE, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:ROSS
Authorized Official - Last Name:MERSINGER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:630-887-9400
Mailing Address - Street 1:555 PLAINFIELD RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:WILLOWBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60527-7602
Mailing Address - Country:US
Mailing Address - Phone:630-887-9400
Mailing Address - Fax:630-887-9495
Practice Address - Street 1:555 PLAINFIELD RD
Practice Address - Street 2:SUITE B
Practice Address - City:WILLOWBROOK
Practice Address - State:IL
Practice Address - Zip Code:60527-7602
Practice Address - Country:US
Practice Address - Phone:630-887-9400
Practice Address - Fax:630-887-9495
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-22
Last Update Date:2007-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL213068OtherGROUP PROVIDER NUMBER