Healthcare Provider Details

I. General information

NPI: 1447311659
Provider Name (Legal Business Name): CHIROPRACTIC ARTS CENTER OF MORTON GROVE, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 12/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6032 LINCOLN AVE
MORTON GROVE IL
60053-2955
US

IV. Provider business mailing address

6032 LINCOLN AVE
MORTON GROVE IL
60053-2955
US

V. Phone/Fax

Practice location:
  • Phone: 847-470-0047
  • Fax:
Mailing address:
  • Phone: 847-470-0047
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038-009042
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number060-007704
License Number StateIL

VIII. Authorized Official

Name: LINDA ANN PINKUS
Title or Position: PRESIDENT
Credential: DC
Phone: 847-470-0047