Healthcare Provider Details

I. General information

NPI: 1205059912
Provider Name (Legal Business Name): LINCOLN PARK CHIROPRACTIC, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 08/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2202 N LINCOLN AVE SUITE 1
CHICAGO IL
60614-7170
US

IV. Provider business mailing address

2202 N LINCOLN AVE SUITE 1
CHICAGO IL
60614-7170
US

V. Phone/Fax

Practice location:
  • Phone: 773-248-2790
  • Fax: 773-248-2058
Mailing address:
  • Phone: 773-248-2790
  • Fax: 773-248-2058

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number38-007442
License Number StateIL

VIII. Authorized Official

Name: DR. PETER F. ZID
Title or Position: OWNER
Credential: D.C.
Phone: 773-248-2790