14D2122278 CLIA NUMBER - PRO-ACTIVE CARE

Laboratory Demographics

  • CLIA Code: 14D2122278
  • Facility Name: PRO-ACTIVE CARE
  • Facility Address: 4430 N WESTERN AVE
    CHICAGO, IL
    ZIP 60625
  • Facility Phone: 773 279-9344
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: EDGARDO R. VARGAS
  • NPI Number: 1356600712
  • Taxonomy: 111N00000X - Chiropractor

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 14D2122278
LAB Type Physician Office
Facility Name PRO-ACTIVE CARE
Street 4430 N WESTERN AVE
City CHICAGO
State IL
ZIP 60625
Phone 773 279-9344
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/23/2024
Certificate Expiration Date 11/22/2026
Facility Type Physician Office
Lab Director EDGARDO R. VARGAS

Download Record

Download this CLIA record record in Text format: Export

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

Download this CLIA record record in XML format: Export

This page was last updated on: 9/29/2025