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General NPI Number Information
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NPI Number | 1982649364
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Entity Type | Organization
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Legal Business Name | LIFEWORKS CENTRO DE SALUD
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Dates
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Enumeration Date | 06/18/2006
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Last Update Date | 08/13/2008
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Provider Practice Location Address
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Address Line | 1954 DEMPSTER ST
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City | EVANSTON
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State | IL
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Zip | 60202-1016
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Country | US
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Telephone | 847-475-6442
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Fax |
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Provider Business Mailing Address
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Address Line | 1954 DEMPSTER ST
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City | EVANSTON
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State | IL
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Zip | 60202-1016
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Country | US
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Telephone | 847-475-6442
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Fax |
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Authorized Official
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Title or Position | CLINIC DIRECTOR
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Name | DR. JOSE L. AGUILAR JR.
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Credential | D.C.
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Telephone | 847-475-6442
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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 | 038-010421
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License Number State | IL
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