=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114155728
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DR. GREGORY S. HOFFMAN
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/23/2009
-----------------------------------------------------
Last Update Date | 07/14/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 401 W ONTARIO ST SUITE 100
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60654-6957
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 224-944-6112
-----------------------------------------------------
Fax | 847-515-4747
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1307
-----------------------------------------------------
City | BARRINGTON
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60011-1307
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 224-944-6112
-----------------------------------------------------
Fax | 847-515-4747
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PRESIDENT
-----------------------------------------------------
Name | DR. GREGORY S HOFFMAN
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 224-944-6112
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 038008853
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------