HIGHLAND PARK CHIROPRACTIC, SC - NPI NUMBER 1255638680

Summary

Provider Name: HIGHLAND PARK CHIROPRACTIC, SC

NPI Number: 1255638680

Clasification: Chiropractor (111N00000X)

Address:
600 CENTRAL AVE
SUITE 144
HIGHLAND PARK, IL
ZIP 60035

Phone Number: (312) 337-4004



Detailed Information

HIGHLAND PARK CHIROPRACTIC, SC is a chiropractor in Highland Park, IL. The provider is a provider qualified by a Doctor of Chiropractic (D.C.), licensed by the State and who practices chiropractic medicine -that discipline within the healing arts which deals with the nervous system and its relationship to the spinal column and its interrelationship with other body systems. The assigned NPI number for this provider is 1255638680 and is registered as an organization entity type and is a single specialty group.

The provider's business address is:

600 CENTRAL AVE
SUITE 144
HIGHLAND PARK, IL
ZIP 60035-211
Phone: (312) 337-4004
Fax: (312) 337-4060

The provider's authorized official is Steven David Goodman .
The authorized official title is Director and has the following contact phone number (561) 213-7666.

The enumeration date for this NPI number is 2/21/2011 and was last updated on 2/21/2011.

Map - Location of Practice

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Taxonomy Codes

The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1 111N00000X Chiropractor 038-007969 IL Yes

NPI Record

No. Field Name Field Value
1 NPI 1255638680
2 Entity Type Code 2
3 Employer Identification Number EIN
4 Provider Organization Name Legal Business Name HIGHLAND PARK CHIROPRACTIC, SC
5 Provider First Line Business Practice Location Address 600 CENTRAL AVE
6 Provider Second Line Business Practice Location Address SUITE 144
7 Provider Business Practice Location Address City Name HIGHLAND PARK
8 Provider Business Practice Location Address State Name IL
9 Provider Business Practice Location Address Postal Code 600353211
10 Provider Business Practice Location Address Country Code If outside U S US
11 Provider Business Practice Location Address Telephone Number 3123374004
12 Provider Business Practice Location Address Fax Number 3123374060
13 Provider Enumeration Date 2/21/2011
14 Last Update Date 2/21/2011
15 Authorized Official Last Name GOODMAN
16 Authorized Official First Name STEVEN
17 Authorized Official Middle Name DAVID
18 Authorized Official Title or Position DIRECTOR
19 Authorized Official Telephone Number 5612137666
20 Healthcare Provider Taxonomy Code 1 111N00000X
21 Provider License Number 1 038-007969
22 Provider License Number State Code 1 IL
23 Healthcare Provider Primary Taxonomy Switch 1 Y
24 Is Organization Subpart N
25 Authorized Official Name Prefix Text DR.
26 Authorized Official Credential Text D.C.
27 Healthcare Provider Taxonomy Group 1 193400000X SINGLE SPECIALTY GROUP

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This page was last updated on: 9/11/2014
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