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NPI Code Detail

MEDICARE: CHICAGO FAMILY CHIROPRACTIC CARE

MEDICARE: CHICAGO FAMILY CHIROPRACTIC CARE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1305S00000XPoint of Service038.009384IL

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2703750OTHERILMEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11780692988OTHERILNPI 1

General Provider Information

NPI Number : 1255634234
Entity Type Code : Organization
Provider Name (Legal Business Name) : CHICAGO FAMILY CHIROPRACTIC CARE
Provider Business Mailing Address
First Line : 922 W DIVERSEY PKWY
Second Line :
City : CHICAGO
State : IL
Zip : 60614-1416
Country : US
Telephone Number : 773-697-0176
Fax Number : 773-529-0231
Provider Business Practice Location Address
First Line : 922 W DIVERSEY PKWY
Second Line :
City : CHICAGO
State : IL
Zip : 60614-1416
Country : US
Telephone Number : 773-697-0176
Fax Number : 773-529-0231
Authorized Official
Title or Position : DOCTOR/PROVIDER
Name : DR. THOMAS L DONAHUE III
Credential : DC, CCSP
Telephone Number : 773-697-0176
Provider Enumeration Date : 12/13/2010
Last Update Date : 06/20/2018

Similar Medicare Providers

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Practice Location Address:
922 W DIVERSEY PKWY
CHICAGO, IL
60614-1416
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1558487728 — DR. DOUGLAS RYAN KREBS DC
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1255899365 — TIFFANY LAUREN WHITE RD, LDN
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Directions to “CHICAGO FAMILY CHIROPRACTIC CARE ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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