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General NPI Number Information
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NPI Number | 1932398492
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Entity Type | Organization
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Legal Business Name | LAKEFRONT CHIROPRACTIC CENTER P.C.
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Dates
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Enumeration Date | 10/22/2007
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Last Update Date | 04/16/2008
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Provider Practice Location Address
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Address Line | 630 VERNON AVE SUITE F
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City | GLENCOE
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State | IL
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Zip | 60022-1681
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Country | US
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Telephone | 847-835-4700
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Fax |
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Provider Business Mailing Address
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Address Line | 630 VERNON AVE SUITE F
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City | GLENCOE
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State | IL
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Zip | 60022-1681
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Country | US
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Telephone | 847-835-4700
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. WARREN W BRUHL
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Credential |
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Telephone | 847-835-4700
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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 | IL
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