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General NPI Number Information
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NPI Number | 1063253276
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Entity Type | Organization
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Legal Business Name | THE DOC OF WEST LOOP PLLC
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Dates
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Enumeration Date | 06/03/2024
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Last Update Date | 06/03/2024
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Provider Practice Location Address
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Address Line | 1144 W RANDOLPH ST STE 2
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City | CHICAGO
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State | IL
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Zip | 60607-1619
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Country | US
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Telephone | 847-217-4697
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Fax |
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Provider Business Mailing Address
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Address Line | 6600 MAPLE ST
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City | MORTON GROVE
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State | IL
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Zip | 60053-1424
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Country | US
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Telephone | 847-217-4697
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | DR. KAMAL VAID
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Credential | DC
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Telephone | 847-217-4697
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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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