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General NPI Number Information
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NPI Number | 1275766339
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Entity Type | Organization
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Legal Business Name | FAMILY CHIROPRACTIC HEALTH CLINIC
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Dates
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Enumeration Date | 08/24/2009
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Last Update Date | 08/24/2009
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Provider Practice Location Address
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Address Line | 1938 RIDGE RD
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City | HOMEWOOD
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State | IL
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Zip | 60430-1730
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Country | US
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Telephone | 708-299-1883
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Fax |
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Provider Business Mailing Address
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Address Line | 14640 S MCKINLEY AVE
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City | POSEN
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State | IL
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Zip | 60469-1221
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Country | US
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Telephone | 708-275-1394
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Fax |
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | ADRIAN ZARAGOZA
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Credential |
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Telephone | 708-275-1394
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 038011436
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License Number State | IL
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