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General NPI Number Information
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NPI Number | 1477715878
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Entity Type | Organization
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Legal Business Name | ING PALOS CHIROPRACTIC
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Dates
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Enumeration Date | 06/26/2008
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Last Update Date | 08/27/2008
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Provider Practice Location Address
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Address Line | 12309 S HARLEM AVE
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City | PALOS HEIGHTS
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State | IL
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Zip | 60463-1444
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Country | US
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Telephone | 708-448-7772
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Fax | 708-448-4470
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Provider Business Mailing Address
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Address Line | 12309 S HARLEM AVE
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City | PALOS HEIGHTS
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State | IL
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Zip | 60463-1444
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Country | US
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Telephone | 708-448-7772
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Fax | 708-448-4470
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Authorized Official
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Title or Position | OWNER
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Name | DR. WALLACE P ING
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Credential | D.C.
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Telephone | 708-448-7772
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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 | 038-003416
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License Number State | IL
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