Healthcare Provider Details

I. General information

NPI: 1740650696
Provider Name (Legal Business Name): LOPEZ FAMILY CHIROPRACTIC SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2015
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7456 S STATE RD STE 204
BEDFORD PARK IL
60638-6625
US

IV. Provider business mailing address

7456 S STATE RD STE 204
BEDFORD PARK IL
60638-6625
US

V. Phone/Fax

Practice location:
  • Phone: 773-376-1162
  • Fax: 773-376-1162
Mailing address:
  • Phone: 773-376-1162
  • Fax: 773-376-1162

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038012211
License Number StateIL

VIII. Authorized Official

Name: DR. ROBERTO LOPEZ JR.
Title or Position: OWNER OF COMPANY
Credential: DC
Phone: 773-962-7892