Healthcare Provider Details

I. General information

NPI: 1386961886
Provider Name (Legal Business Name): CHICAGO RESEARCH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2010
Last Update Date: 04/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 N CENTRAL AVE
CHICAGO IL
60634-4426
US

IV. Provider business mailing address

3401 N CENTRAL AVE
CHICAGO IL
60634-4426
US

V. Phone/Fax

Practice location:
  • Phone: 773-282-9845
  • Fax: 773-282-9847
Mailing address:
  • Phone: 773-282-9845
  • Fax: 773-282-9847

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744R1102X
TaxonomyResearch Study Specialist
License Number
License Number State

VIII. Authorized Official

Name: MR. ERIC CHRISTOPHER MALM
Title or Position: VICE PRESIDENT
Credential: LCSW
Phone: 773-282-9845