Healthcare Provider Details
I. General information
NPI: 1316593163
Provider Name (Legal Business Name): EVANSTON FAMILY CHIROPRACTIC AND WELLNESS CENTER, S.C.
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 08/16/2019
Last Update Date: 12/11/2019
Certification Date: 12/11/2019
Deactivation Date:
Reactivation Date:
III. Provider practice location address
705 MAIN ST
EVANSTON IL
60202-1701
US
IV. Provider business mailing address
705 MAIN ST
EVANSTON IL
60202-1701
US
V. Phone/Fax
- Phone: 847-732-8876
- Fax:
- Phone: 847-732-8876
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 111N00000X |
| Taxonomy | Chiropractor |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name: DR.
SEAN
DEVIN
CURRY
Title or Position: PRESIDENT/OWNER
Credential: DC
Phone: 847-732-8876