Healthcare Provider Details

I. General information

NPI: 1205062775
Provider Name (Legal Business Name): ALT FAMILY CHIROPRACTIC, S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2009
Last Update Date: 06/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1314 SPRING ST.
SOUTH ELGIN IL
60177-2972
US

IV. Provider business mailing address

1314 SPRING ST.
SOUTH ELGIN IL
60177-2972
US

V. Phone/Fax

Practice location:
  • Phone: 847-695-7714
  • Fax: 847-695-7716
Mailing address:
  • Phone: 847-695-7714
  • Fax: 847-695-7716

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number038011200
License Number StateIL

VIII. Authorized Official

Name: DR. ADAM TILSON
Title or Position: PRESIDENT
Credential: D.C.
Phone: 847-695-7714