Healthcare Provider Details

I. General information

NPI: 1053669580
Provider Name (Legal Business Name): CATALYST CHIROPRACTIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2012
Last Update Date: 08/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

313 W MAPLE ST
NEW LENOX IL
60451-1633
US

IV. Provider business mailing address

313 W MAPLE ST
NEW LENOX IL
60451-1633
US

V. Phone/Fax

Practice location:
  • Phone: 815-312-4922
  • Fax: 773-337-9106
Mailing address:
  • Phone: 815-312-4922
  • Fax: 773-337-9106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038012158
License Number StateIL

VIII. Authorized Official

Name: LYNNETTE MCROY
Title or Position: BILLING COORDINATOR
Credential:
Phone: 773-767-3822