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General NPI Number Information
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NPI Number | 1124168281
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Entity Type | Organization
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Legal Business Name | SOUTH SUBURBAN CHIROPRACTIC CLINIC PC
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Dates
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Enumeration Date | 02/07/2007
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 14277 S. WOLF RD.
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City | ORLAND PARK
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State | IL
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Zip | 60467
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Country | US
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Telephone | 708-403-3252
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Fax | 708-403-3251
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Provider Business Mailing Address
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Address Line | 14277 WOLF RD
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City | ORLAND PARK
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State | IL
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Zip | 60467-1932
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Country | US
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Telephone | 708-403-3252
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Fax | 702-403-3251
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | KATHY ANNE GRENNELL
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Credential |
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Telephone | 708-403-3252
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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 | IL
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