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General NPI Number Information
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NPI Number | 1649460270
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Entity Type | Organization
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Legal Business Name | CHIROPRACTIC AND ACUPUNCTURE CENTER INC
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Dates
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Enumeration Date | 07/30/2007
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Last Update Date | 03/30/2023
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Provider Practice Location Address
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Address Line | 2604 DEMPSTER ST SUITE 304
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City | PARK RIDGE
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State | IL
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Zip | 60068-8412
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Country | US
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Telephone | 847-635-8080
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Fax | 847-390-8080
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Provider Business Mailing Address
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Address Line | 2604 DEMPSTER ST SUITE 304
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City | PARK RIDGE
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State | IL
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Zip | 60068-8412
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Country | US
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Telephone | 847-635-8080
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Fax | 847-390-8080
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | KEVIN PATRICK MOORE
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Credential |
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Telephone | 847-635-8080
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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 | 038-005366
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License Number State | IL
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