1245352160 NPI number — CARE CHIROPRACTIC CENTER P.C.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245352160 NPI number — CARE CHIROPRACTIC CENTER P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CARE CHIROPRACTIC CENTER P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1245352160
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/23/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1555 N. BARRINGTON ROAD
Provider Second Line Business Mailing Address:
DOCTOR'S BUILDING ONE, SUITE 335
Provider Business Mailing Address City Name:
HOFFMAN ESTATES
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60169-1144
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-885-1131
Provider Business Mailing Address Fax Number:
847-839-0910

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1555 N. BARRINGTON ROAD
Provider Second Line Business Practice Location Address:
DOCTOR'S BUILDING ONE, SUITE 335
Provider Business Practice Location Address City Name:
HOFFMAN ESTATES
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60169-1144
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-885-1131
Provider Business Practice Location Address Fax Number:
847-839-0910
Provider Enumeration Date:
04/03/2007

Additional Information

Authorized Official

Authorized Official Last Name:
PANTANELLA
Authorized Official First Name:
ANTHONY
Authorized Official Middle Name:
CHARLES
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
847-885-1131

Provider Taxonomy Codes

  • Taxonomy code: 111NI0900X , with the licence number:  038-005177 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0001636402 . This is a "BLUE SHIELD PROVIDER #" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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