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General NPI Number Information
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NPI Number | 1639401144
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Entity Type | Organization
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Legal Business Name | CITY CENTER CHIROPRACTIC AND REHABILITATION LLC
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Dates
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Enumeration Date | 02/08/2010
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Last Update Date | 06/13/2011
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Provider Practice Location Address
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Address Line | 300 W ADAMS ST 515
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City | CHICAGO
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State | IL
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Zip | 60606-5101
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Country | US
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Telephone | 312-223-0692
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Fax | 312-223-0695
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Provider Business Mailing Address
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Address Line | 300 W ADAMS ST 515
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City | CHICAGO
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State | IL
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Zip | 60606-5101
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Country | US
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Telephone | 312-223-0692
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Fax | 312-223-0695
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Authorized Official
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Title or Position | OWNER/PHYSICIAN
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Name | DR. JULIE ANNE MIESMER
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Credential | DC
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Telephone | 312-223-0692
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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 | 038009296
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License Number State | IL
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