Healthcare Provider Details

I. General information

NPI: 1346426319
Provider Name (Legal Business Name): LOS QUIROPRACTICOS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/21/2008
Last Update Date: 03/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 S MCLEAN BLVD STE N
ELGIN IL
60123-1023
US

IV. Provider business mailing address

PO BOX 5603
OXNARD CA
93031-5603
US

V. Phone/Fax

Practice location:
  • Phone: 847-697-1234
  • Fax: 847-697-8205
Mailing address:
  • Phone: 805-487-4043
  • Fax: 805-487-4003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC24189
License Number StateIL

VIII. Authorized Official

Name: MR. MICHAEL SHOAR
Title or Position: OWNER
Credential: D.C.
Phone: 805-487-4043