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

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 Field Definition 1
1 NPI 1255638680 The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
2 Entity Type Code 2 Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
3 Employer Identification Number EIN The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
4 Provider Organization Name Legal Business Name HIGHLAND PARK CHIROPRACTIC, SC The name of the organization provider. If the provider is an organization, this is the legal business name.
5 Provider First Line Business Practice Location Address 600 CENTRAL AVE The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
6 Provider Second Line Business Practice Location Address SUITE 144 The second line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
7 Provider Business Practice Location Address City Name HIGHLAND PARK The city name in the location address of the provider being identified.
8 Provider Business Practice Location Address State Name IL The State code in the location of the provider being identified.
9 Provider Business Practice Location Address Postal Code 600353211 The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
10 Provider Business Practice Location Address Country Code If outside U S US The country code in the location address of the provider being identified.
11 Provider Business Practice Location Address Telephone Number 3123374004 The telephone number associated with the location address of the provider being identified.
12 Provider Business Practice Location Address Fax Number 3123374060 The fax number associated with the location address of the provider being identified.
13 Provider Enumeration Date 2/21/2011 The date the provider was assigned a unique identifier (assigned an NPI).
14 Last Update Date 2/21/2011 The date that a record was last updated or changed.
15 Authorized Official Last Name GOODMAN The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
16 Authorized Official First Name STEVEN The first name of the authorized official.
17 Authorized Official Middle Name DAVID The middle name of the authorized official.
18 Authorized Official Title or Position DIRECTOR The title or position of the authorized official.
19 Authorized Official Telephone Number 5612137666 The 10-position telephone number of the authorized official.
20 Healthcare Provider Taxonomy Code 1 111N00000X Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
21 Provider License Number 1 038-007969 The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
22 Provider License Number State Code 1 IL The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
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

Similar Providers Nearby

NPI Provider Name NPI Type Taxonomy
1013090661 DR. MARCUS WAYNE JOHNSON, D.C. Individual Chiropractor
1063521672 DR. VINCENT ELLIOT SEILER, DC Individual Chiropractor
1003925983 DR. SUSAN LYNN STREIFF, D.C. Individual Chiropractor
1073693008 LGN LTD Organization Chiropractor
1083043921 DR. MICHEALE KELEHER Individual Chiropractor
1093949059 ROSS CHIROPRACTIC LLC Organization Chiropractor (Internist)
1003920265 TERRENCE MILLER Individual Chiropractor
1023331170 HOLCOMB FAMILY CHIROPRACTIC Organization Chiropractor
1114077609 BRYAN HUITZACUA Individual Chiropractor
1083965339 KARI CRAWFORD DC Organization Chiropractor
1073599312 DR. BRADLEY J LEWIS, DC Individual Chiropractor
1124399381 HAINESVILLE CHIRPORACTIC Organization Chiropractor


Download NPI Record

Download this NPI record in Text format: Export

Download this NPI record in Excel (CSV) format: Export

Download this NPI record in XML format: Export




This page was last updated on: 4/19/2015

(1) Field Definition Source-. Federal Register / Vol. 69, No. 15 / Friday, January 23, 2004 / Rules and Regulations - Part II Department of Health and Human Services Office of the Secretary 45 CFR Part 162 HIPAA Administrative Simplification: Standard Unique Health Identifier for Health Care Providers; Final Rule

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.