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General NPI Number Information
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NPI Number | 1316674468
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Entity Type | Organization
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Legal Business Name | NORTHCENTER CHIROPRACTIC CORPORATION
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Dates
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Enumeration Date | 08/08/2022
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Last Update Date | 08/08/2022
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Provider Practice Location Address
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Address Line | 1820 W IRVING PARK RD STE 200
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City | CHICAGO
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State | IL
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Zip | 60613-2406
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Country | US
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Telephone | 773-316-2400
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Fax | 773-313-3538
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Provider Business Mailing Address
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Address Line | 3232 W WILSON AVE UNIT 1
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City | CHICAGO
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State | IL
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Zip | 60625-4411
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Country | US
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Telephone | 773-316-2400
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Fax | 773-313-3538
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. DANIEL JACOBAZZI
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Credential | DC
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Telephone | 773-316-2400
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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 |
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