Healthcare Provider Details

I. General information

NPI: 1679743900
Provider Name (Legal Business Name): SUBURBAN CHIROPRACTIC-LANSING, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

18525 TORRENCE AVE STE F3
LANSING IL
60438-2891
US

IV. Provider business mailing address

18525 TORRENCE AVE STE F3
LANSING IL
60438-2891
US

V. Phone/Fax

Practice location:
  • Phone: 708-418-5505
  • Fax: 708-418-5531
Mailing address:
  • Phone: 708-418-5505
  • Fax: 708-418-5531

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number038-007368
License Number StateIL

VIII. Authorized Official

Name: DR. SCOTT YODER
Title or Position: OWNER/PRESIDENT
Credential: DC
Phone: 708-418-5505