Healthcare Provider Details

I. General information

NPI: 1932219391
Provider Name (Legal Business Name): IFEOMA CHINYERE OKORAFOR-CHIDUME D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 02/15/2021
Certification Date: 02/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2103 CRAWFORD AVE
EVANSTON IL
60201-1822
US

IV. Provider business mailing address

5360 N LINCOLN AVE
CHICAGO IL
60625-2316
US

V. Phone/Fax

Practice location:
  • Phone: 847-332-2225
  • Fax:
Mailing address:
  • Phone: 773-723-3300
  • Fax: 773-723-3603

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038008720
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: