Healthcare Provider Details

I. General information

NPI: 1164901906
Provider Name (Legal Business Name): CHICAGO NATURAL HEALTH CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2018
Last Update Date: 08/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3432 W DIVERSEY AVE STE 253
CHICAGO IL
60647-1221
US

IV. Provider business mailing address

5443 N GLENWOOD AVE
CHICAGO IL
60640-1226
US

V. Phone/Fax

Practice location:
  • Phone: 773-418-6877
  • Fax:
Mailing address:
  • Phone: 773-418-6877
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. ANTHONY CRIFASE
Title or Position: OWNER
Credential: DC, CNS
Phone: 773-418-6877