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General NPI Number Information
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NPI Number | 1851631154
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Entity Type | Organization
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Legal Business Name | AFFINITY CHIROPRACTIC AND REHABILITATION, LLC
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Dates
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Enumeration Date | 02/22/2013
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Last Update Date | 12/14/2015
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Provider Practice Location Address
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Address Line | 1518 E. 63RD ST.
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City | CHICAGO
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State | IL
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Zip | 60637-2921
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Country | US
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Telephone | 773-241-6600
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Fax | 773-363-7822
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Provider Business Mailing Address
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Address Line | 1518 E 63RD ST.
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City | CHICAGO
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State | IL
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Zip | 60637-2921
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Country | US
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Telephone | 312-225-1100
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Fax | 773-363-7822
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Authorized Official
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Title or Position | PRESIDENT
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Name | TAMIKO MICHELLE LIBURD
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Credential |
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Telephone | 630-885-0378
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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 | 038.012205
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License Number State | IL
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