Healthcare Provider Details

I. General information

NPI: 1336166164
Provider Name (Legal Business Name): ILZE LIEPINS DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1605 S MICHIGAN AVENUE
CHICAGO IL
60616
US

IV. Provider business mailing address

1605 S MICHIGAN AVENUE
CHICAGO IL
60616
US

V. Phone/Fax

Practice location:
  • Phone: 312-212-1404
  • Fax: 312-212-1434
Mailing address:
  • Phone: 312-212-1404
  • Fax: 312-212-1434

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NI0900X
TaxonomyInternist Chiropractor
License Number038010399
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: