Healthcare Provider Details

I. General information

NPI: 1598834525
Provider Name (Legal Business Name): LAKEVIEW FAMILY CHIROPRACTIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 09/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3178 N BROADWAY ST
CHICAGO IL
60657-4509
US

IV. Provider business mailing address

3178 N BROADWAY ST
CHICAGO IL
60657-4509
US

V. Phone/Fax

Practice location:
  • Phone: 773-549-6400
  • Fax: 773-549-6401
Mailing address:
  • Phone: 773-549-6400
  • Fax: 773-549-6401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038008006
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number2682
License Number StateNC

VIII. Authorized Official

Name: DR. MARK ALLEN SLOAN
Title or Position: OWNER
Credential: D.C.
Phone: 773-549-6400