Provider Demographics
NPI:1932233269
Name:LIGHTHOUSE FAMILY CHIROPRACTIC, LTD
Entity Type:Organization
Organization Name:LIGHTHOUSE FAMILY CHIROPRACTIC, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHERYAR
Authorized Official - Middle Name:
Authorized Official - Last Name:MASUD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-443-4411
Mailing Address - Street 1:525 TYLER RD
Mailing Address - Street 2:UNIT R-1
Mailing Address - City:ST CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60174-3305
Mailing Address - Country:US
Mailing Address - Phone:630-443-4411
Mailing Address - Fax:630-443-7351
Practice Address - Street 1:525 TYLER RD
Practice Address - Street 2:UNIT R-1
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60174-3305
Practice Address - Country:US
Practice Address - Phone:630-443-4411
Practice Address - Fax:630-443-7351
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2013-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038008235111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL04527125OtherBLUE CROSS BLUE SHEILD
212230Medicare PIN
IL212230Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER