Healthcare Provider Details

I. General information

NPI: 1679796973
Provider Name (Legal Business Name): CHIROPRACTIC CONNECTION LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 02/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1440 W NORTH AVE SUITE 307
MELROSE PARK IL
60160-1422
US

IV. Provider business mailing address

1440 W NORTH AVE SUITE 307
MELROSE PARK IL
60160-1422
US

V. Phone/Fax

Practice location:
  • Phone: 708-345-1299
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038-008863
License Number StateIL

VIII. Authorized Official

Name: DEREK ZID
Title or Position: OWNER
Credential: DC
Phone: 708-345-1299