Provider Demographics
NPI:1952591448
Name:ORION DIAGNOSTIC & CHIROPRACTIC CENTER
Entity Type:Organization
Organization Name:ORION DIAGNOSTIC & CHIROPRACTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KHALED
Authorized Official - Middle Name:A
Authorized Official - Last Name:KHORSHID
Authorized Official - Suffix:
Authorized Official - Credentials:CD
Authorized Official - Phone:708-288-2239
Mailing Address - Street 1:9004 RIDGELAND AVE
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-1414
Mailing Address - Country:US
Mailing Address - Phone:708-288-2239
Mailing Address - Fax:708-233-6167
Practice Address - Street 1:9830 S. RIDGELAND AVE
Practice Address - Street 2:SUITE # 5
Practice Address - City:CHICAGO RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60415
Practice Address - Country:US
Practice Address - Phone:708-288-2239
Practice Address - Fax:708-233-6167
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-31
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038008190111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL647758OtherACN
ILK08024OtherMEDICARE MEMBER NUMBER
IL01633049OtherBC/BS
IL01633049OtherBC/BS
ILU71814Medicare UPIN