Provider Demographics
NPI:1932219391
Name:OKORAFOR-CHIDUME, IFEOMA CHINYERE (DC)
Entity Type:Individual
Prefix:DR
First Name:IFEOMA
Middle Name:CHINYERE
Last Name:OKORAFOR-CHIDUME
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5360 N LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-2316
Mailing Address - Country:US
Mailing Address - Phone:773-723-3300
Mailing Address - Fax:773-723-3603
Practice Address - Street 1:2103 CRAWFORD AVE
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-1822
Practice Address - Country:US
Practice Address - Phone:847-332-2225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2021-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038008720111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL038008720Medicaid
IL038008720Medicaid
ILU74687Medicare UPIN