Healthcare Provider Details

I. General information

NPI: 1295089712
Provider Name (Legal Business Name): LAGRANGE INSTITUTE OF HEALTH LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2012
Last Update Date: 06/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

430 W ERIE ST SUITE 403
CHICAGO IL
60654-6914
US

IV. Provider business mailing address

430 W ERIE ST SUITE 403
CHICAGO IL
60654-6914
US

V. Phone/Fax

Practice location:
  • Phone: 312-255-8810
  • Fax: 312-846-6817
Mailing address:
  • Phone: 312-255-8810
  • Fax: 312-846-6817

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number038010610
License Number StateIL

VIII. Authorized Official

Name: DR. GINA MARIE SIRCHIO
Title or Position: OWNER/PROVIDER
Credential: DC
Phone: 312-255-8810