Provider Demographics
NPI:1841661774
Name:PETRAK FAMILY CHIROPRACTIC CENTER S.C
Entity type:Organization
Organization Name:PETRAK FAMILY CHIROPRACTIC CENTER S.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:PETRAK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:630-853-9971
Mailing Address - Street 1:3070 SOUTH WOLF RD
Mailing Address - Street 2:
Mailing Address - City:WESTCHESTER
Mailing Address - State:IL
Mailing Address - Zip Code:60154
Mailing Address - Country:US
Mailing Address - Phone:630-853-9971
Mailing Address - Fax:
Practice Address - Street 1:3070 SOUTH WOLF RD
Practice Address - Street 2:
Practice Address - City:WESTCHESTER
Practice Address - State:IL
Practice Address - Zip Code:60154
Practice Address - Country:US
Practice Address - Phone:630-853-9971
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-19
Last Update Date:2015-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty