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NPI Code Detail

MEDICARE: WEST LOOP CHIROPRACTIC & SPORTS INJURY CENTER LTD.

MEDICARE: WEST LOOP CHIROPRACTIC & SPORTS INJURY CENTER LTD.
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
1111N00000XChiropractor038.008065IL
2111NS0005XSports Physician Chiropractor038.008065IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11093789216OTHERILINDIVIDUAL NPI NUMBER

General Provider Information

NPI Number : 1598021388
Entity Type Code : Organization
Provider Name (Legal Business Name) : WEST LOOP CHIROPRACTIC & SPORTS INJURY CENTER LTD.
Provider Business Mailing Address
First Line : 16 N PEORIA ST
Second Line : SUITE 101A
City : CHICAGO
State : IL
Zip : 60607-2609
Country : US
Telephone Number : 312-346-9355
Fax Number : 312-346-9356
Provider Business Practice Location Address
First Line : 16 N PEORIA ST
Second Line : SUITE 101A
City : CHICAGO
State : IL
Zip : 60607-2609
Country : US
Telephone Number : 312-346-9355
Fax Number : 312-346-9356
Authorized Official
Title or Position : OWNER
Name : DR. ALDEN CLENDENIN
Credential : D.C.
Telephone Number : 312-346-9355
Provider Enumeration Date : 04/05/2012
Last Update Date : 06/05/2012

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Directions to “WEST LOOP CHIROPRACTIC & SPORTS INJURY CENTER LTD. ” Practice Location

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