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General NPI Number Information
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NPI Number | 1124205414
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Entity Type | Organization
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Legal Business Name | LOS QUIROPRACTICOS, LLC
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Dates
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Enumeration Date | 01/29/2008
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Last Update Date | 01/29/2008
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Provider Practice Location Address
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Address Line | 1806 W 18TH ST
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City | CHICAGO
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State | IL
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Zip | 60608-1944
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Country | US
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Telephone | 312-850-4433
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Fax | 312-580-4434
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Provider Business Mailing Address
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Address Line | 1806 W 18TH ST
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City | CHICAGO
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State | IL
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Zip | 60608-1944
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Country | US
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Telephone | 312-850-4433
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Fax | 312-580-4434
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Authorized Official
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Title or Position | OWNER
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Name | MR. MICHAEL SHOAR
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Credential | D.C.
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Telephone | 805-487-4043
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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 | 24189
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License Number State | IL
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