Healthcare Provider Details

I. General information

NPI: 1861235863
Provider Name (Legal Business Name): XCLUSIVE CHIROPRACTIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2024
Last Update Date: 06/17/2024
Certification Date: 06/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16335 HARLEM AVE STE 150-2
TINLEY PARK IL
60477-2574
US

IV. Provider business mailing address

16335 HARLEM AVE STE 150-2
TINLEY PARK IL
60477-2574
US

V. Phone/Fax

Practice location:
  • Phone: 708-829-3941
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHELLE BLANTON
Title or Position: OWNER
Credential: DC
Phone: 708-829-3941