Healthcare Provider Details

I. General information

NPI: 1790967495
Provider Name (Legal Business Name): FAMILY CHIROPRACTIC PHYSICIANS, LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2007
Last Update Date: 10/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 W ARMY TRAIL BLVD STE A
ADDISON IL
60101-3299
US

IV. Provider business mailing address

601 W ARMY TRAIL BLVD STE A
ADDISON IL
60101-3299
US

V. Phone/Fax

Practice location:
  • Phone: 630-543-1929
  • Fax: 630-543-1931
Mailing address:
  • Phone: 630-543-1929
  • Fax: 630-543-1931

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070016639
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038009041
License Number StateIL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier2223667
Identifier TypeOTHER
Identifier StateIL
Identifier IssuerBCBSI

VIII. Authorized Official

Name: DR. ANTHONY M PIRIE
Title or Position: PRESIDENT
Credential: D.C.
Phone: 630-543-1929