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NPI Code Detail

MEDICARE: DR. ALDEN CLENDENIN DC, CCSP

MEDICARE: DR. ALDEN CLENDENIN DC, CCSP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1111NS0005XSports Physician Chiropractor038-008065IL

General Provider Information

NPI Number : 1093789216
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ALDEN CLENDENIN DC, CCSP
Provider Business Mailing Address
First Line : 16 N PEORIA ST
Second Line :
City : CHICAGO
State : IL
Zip : 60607-2609
Country : US
Telephone Number : 312-346-9355
Fax Number :
Provider Business Practice Location Address
First Line : 16 N PEORIA ST
Second Line :
City : CHICAGO
State : IL
Zip : 60607-2609
Country : US
Telephone Number : 312-346-9355
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/14/2006
Last Update Date : 02/01/2012

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