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General NPI Number Information
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NPI Number | 1255634234
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Entity Type | Organization
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Legal Business Name | CHICAGO FAMILY CHIROPRACTIC CARE
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Dates
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Enumeration Date | 12/13/2010
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Last Update Date | 06/20/2018
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Provider Practice Location Address
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Address Line | 922 W DIVERSEY PKWY
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City | CHICAGO
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State | IL
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Zip | 60614-1416
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Country | US
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Telephone | 773-697-0176
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Fax | 773-529-0231
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Provider Business Mailing Address
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Address Line | 922 W DIVERSEY PKWY
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City | CHICAGO
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State | IL
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Zip | 60614-1416
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Country | US
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Telephone | 773-697-0176
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Fax | 773-529-0231
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Authorized Official
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Title or Position | DOCTOR/PROVIDER
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Name | DR. THOMAS L DONAHUE III
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Credential | DC, CCSP
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Telephone | 773-697-0176
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number | 038.009384
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License Number State | IL
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