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General NPI Number Information
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NPI Number | 1104926344
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Entity Type | Organization
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Legal Business Name | HYDE PARK CHIROPRACTIC WELLNESS CENTER SC
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Dates
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Enumeration Date | 09/25/2006
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Last Update Date | 01/11/2023
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Provider Practice Location Address
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Address Line | 1304 E 47TH ST STE 201
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City | CHICAGO
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State | IL
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Zip | 60653-4695
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Country | US
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Telephone | 773-493-7034
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Fax | 773-493-5521
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Provider Business Mailing Address
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Address Line | 1304 E 47TH ST STE 201
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City | CHICAGO
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State | IL
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Zip | 60653-4695
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Country | US
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Telephone | 773-493-7034
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Fax | 773-493-5521
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Authorized Official
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Title or Position | OWNER
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Name | DR. ROLANDE D BALAN
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Credential | DC
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Telephone | 773-493-7034
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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 | 038007681
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License Number State | IL
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