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General NPI Number Information
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NPI Number | 1750872990
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Entity Type | Organization
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Legal Business Name | EXPERIENCE CHIROPRACTIC SC
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Dates
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Enumeration Date | 05/23/2018
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Last Update Date | 05/23/2018
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Provider Practice Location Address
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Address Line | 1971 N FREMONT ST STE 3
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City | CHICAGO
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State | IL
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Zip | 60614-3591
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Country | US
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Telephone | 773-569-3014
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Fax |
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Provider Business Mailing Address
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Address Line | 1971 N FREMONT ST STE 3
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City | CHICAGO
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State | IL
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Zip | 60614-3591
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JENNIFER NUDO
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Credential | DC
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Telephone | 618-841-0078
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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 |
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License Number State |
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