Healthcare Provider Details

I. General information

NPI: 1083886956
Provider Name (Legal Business Name): LAKE COOK CHIROPRACTIC HEALTH CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2008
Last Update Date: 03/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20370 RAND RD SUITE 104
KILDEER IL
60074-2058
US

IV. Provider business mailing address

20370 RAND RD SUITE 104
KILDEER IL
60074-2058
US

V. Phone/Fax

Practice location:
  • Phone: 847-726-2273
  • Fax: 847-726-2274
Mailing address:
  • Phone: 847-726-2273
  • Fax: 847-726-2274

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038-006836
License Number StateIL

VIII. Authorized Official

Name: DR. GUY WILLIAM GAROZZO
Title or Position: CHIROPRACTIC PHYSICIAN
Credential: D.C.
Phone: 847-726-2273