1821386814 NPI number — CHICAGO PREMIUM CHIROPRACTIC INC.

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 1821386814 NPI number — CHICAGO PREMIUM CHIROPRACTIC INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHICAGO PREMIUM CHIROPRACTIC INC.
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:
1821386814
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/12/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
791 DUNHILL DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BUFFALO GROVE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60089-1514
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-229-0513
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3000 DUNDEE RD
Provider Second Line Business Practice Location Address:
308
Provider Business Practice Location Address City Name:
NORTHBROOK
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60062-2422
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-272-7727
Provider Business Practice Location Address Fax Number:
847-272-7673
Provider Enumeration Date:
07/12/2011

Additional Information

Authorized Official

Authorized Official Last Name:
AYZENSHTEYN
Authorized Official First Name:
ALEXANDER
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
847-254-4970

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  038.011825 , 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)





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