Healthcare Provider Details

I. General information

NPI: 1457642936
Provider Name (Legal Business Name): SHAMIKA CORDIS D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2011
Last Update Date: 02/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3927 W BELMONT AVE STE 101
CHICAGO IL
60618-5170
US

IV. Provider business mailing address

PO BOX 5977 DEPT 20-3028
CAROL STREAM IL
60197-5977
US

V. Phone/Fax

Practice location:
  • Phone: 773-557-7780
  • Fax: 773-557-7781
Mailing address:
  • Phone: 630-468-1824
  • Fax: 630-701-1007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038012064
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: