Healthcare Provider Details

I. General information

NPI: 1467876318
Provider Name (Legal Business Name): CHICAGO INJURY SPECIALISTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2014
Last Update Date: 02/16/2023
Certification Date: 02/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2548 S BLUE ISLAND AVE
CHICAGO IL
60608
US

IV. Provider business mailing address

2332 S TRUMBULL AVE
CHICAGO IL
60623-3221
US

V. Phone/Fax

Practice location:
  • Phone: 773-954-4438
  • Fax: 773-823-1746
Mailing address:
  • Phone: 773-610-9738
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number238000485
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038009097
License Number StateIL

VIII. Authorized Official

Name: MIGUEL A JIMENEZ
Title or Position: ADMINISTRATOR
Credential: DC
Phone: 773-954-4438