Provider Demographics
NPI:1932218583
Name:NORRIDGE CHIROPRACTIC CLINIC LTD
Entity Type:Organization
Organization Name:NORRIDGE CHIROPRACTIC CLINIC LTD
Other - Org Name:TOTAL LIFE CHIROPRACTIC
Other - Org Type:Other Name
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:J
Authorized Official - Last Name:MARTUSCIELLO
Authorized Official - Suffix:
Authorized Official - Credentials:DC DABCO
Authorized Official - Phone:708-457-8000
Mailing Address - Street 1:7830 W LAWRENCE AVE
Mailing Address - Street 2:
Mailing Address - City:NORRIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60706
Mailing Address - Country:US
Mailing Address - Phone:708-457-8000
Mailing Address - Fax:708-457-1333
Practice Address - Street 1:7830 W LAWRENCE AVE
Practice Address - Street 2:
Practice Address - City:NORRIDGE
Practice Address - State:IL
Practice Address - Zip Code:60706
Practice Address - Country:US
Practice Address - Phone:708-457-8000
Practice Address - Fax:708-457-1333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2011-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038004983111N00000X
IL038008935111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL277958200OtherDEPT OF LABOR
IL1682591OtherBCBS
IL1682591OtherBCBS
U9976Medicare UPIN
IL277958200OtherDEPT OF LABOR
U79088Medicare UPIN