Healthcare Provider Details

I. General information

NPI: 1235287624
Provider Name (Legal Business Name): CHIROPRACTIC FOR LIFE L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5138 N CLARK ST
CHICAGO IL
60640-2828
US

IV. Provider business mailing address

5138 N CLARK ST
CHICAGO IL
60640-2828
US

V. Phone/Fax

Practice location:
  • Phone: 773-878-8933
  • Fax: 773-878-5247
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ANN GENERALI
Title or Position: PARTNER
Credential: D.C.
Phone: 773-878-8933