Healthcare Provider Details

I. General information

NPI: 1982829545
Provider Name (Legal Business Name): CHIROCHICAGO CHIROPRACTIC & SPORTS INJURY CENTER, LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 N DEARBORN ST SUITE 2323
CHICAGO IL
60602-3102
US

IV. Provider business mailing address

920 W MADISON ST UNIT F6
CHICAGO IL
60607-2718
US

V. Phone/Fax

Practice location:
  • Phone: 312-422-0042
  • Fax: 312-422-0045
Mailing address:
  • Phone: 312-422-0042
  • Fax: 312-422-0045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. RENALD ALEXANDER TROTTIER
Title or Position: PRESIDENT
Credential: D.C.
Phone: 312-422-0042