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General NPI Number Information
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NPI Number | 1346584513
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Entity Type | Organization
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Legal Business Name | LIFECLINIC CHIROPRACTIC OF ILLINOIS LLC
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Dates
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Enumeration Date | 11/12/2012
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Last Update Date | 07/24/2021
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Provider Practice Location Address
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Address Line | 2000 OAKBROOK CTR
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City | OAK BROOK
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State | IL
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Zip | 60523-9002
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Country | US
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Telephone | 630-203-5458
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 549
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City | CHANHASSEN
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State | MN
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Zip | 55317-0549
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Country | US
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Telephone | 952-229-7558
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Fax | 952-474-1504
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Authorized Official
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Title or Position | OWNER
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Name | DR. REZA P ALIZADEH
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Credential | DC
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Telephone | 651-690-0866
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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 | 038.12283
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License Number State | IL
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