Healthcare Provider Details

I. General information

NPI: 1033030564
Provider Name (Legal Business Name): CHICAGO ANTI-AGING INSTITUTION 2, SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14497 JOHN HUMPHREY DR STE 101
ORLAND PARK IL
60462-2637
US

IV. Provider business mailing address

14497 JOHN HUMPHREY DR STE 101
ORLAND PARK IL
60462-2637
US

V. Phone/Fax

Practice location:
  • Phone: 815-905-3506
  • Fax: 815-905-3822
Mailing address:
  • Phone: 815-905-3506
  • Fax: 815-905-3822

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code202D00000X
TaxonomyIntegrative Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. LOREN DAVIS
Title or Position: PRESIDENT
Credential: DC
Phone: 708-267-2164