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General NPI Number Information
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NPI Number | 1275726002
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Entity Type | Organization
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Legal Business Name | WAITERS CHIROPRACTIC WELLNESS CENTER, LTD
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Dates
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Enumeration Date | 08/24/2007
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Last Update Date | 08/24/2007
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Provider Practice Location Address
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Address Line | 217 E 31ST ST
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City | CHICAGO
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State | IL
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Zip | 60616-4667
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Country | US
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Telephone | 312-326-4444
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Fax |
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Provider Business Mailing Address
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Address Line | 217 E 31ST ST
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City | CHICAGO
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State | IL
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Zip | 60616-4667
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Country | US
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Telephone | 312-326-4444
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ITASCA WAITERS
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Credential | D.C
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Telephone | 312-326-4444
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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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