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General NPI Number Information
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NPI Number | 1336489590
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Entity Type | Organization
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Legal Business Name | COMPLETE CHICAGO CHIROPRACTIC AND SPORTS MEDICINE LTD
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Dates
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Enumeration Date | 02/26/2013
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Last Update Date | 02/26/2013
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Provider Practice Location Address
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Address Line | 7311 W FOREST PRESERVE AVE
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City | CHICAGO
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State | IL
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Zip | 60634-3505
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Country | US
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Telephone | 773-625-2424
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Fax | 773-625-2448
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Provider Business Mailing Address
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Address Line | 7311 W FOREST PRESERVE AVE
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City | CHICAGO
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State | IL
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Zip | 60634-3505
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Country | US
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Telephone | 773-625-2424
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Fax | 773-625-2448
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. EMMANUEL ANGELO GIOVANIS
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Credential | D.C.
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Telephone | 773-625-2424
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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 | 038009682
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License Number State | IL
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