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General NPI Number Information
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NPI Number | 1063031003
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Entity Type | Organization
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Legal Business Name | BAZAN'S HEALTH CENTER INC
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Dates
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Enumeration Date | 04/09/2020
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Last Update Date | 04/09/2020
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Provider Practice Location Address
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Address Line | 4012 W 63RD ST
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City | CHICAGO
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State | IL
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Zip | 60629-4606
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Country | US
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Telephone | 773-306-1928
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Fax | 773-498-6596
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Provider Business Mailing Address
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Address Line | 6001 S KEATING AVE # 1
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City | CHICAGO
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State | IL
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Zip | 60629-5409
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Country | US
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Telephone | 630-452-3889
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Fax | 773-498-6596
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Authorized Official
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Title or Position | CHIROPRACTIC PHYSICIAN
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Name | DR. DELTON BAZAN-PECHE
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Credential | DC
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Telephone | 630-452-3889
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State |
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