Provider Demographics
NPI:1447311659
Name:CHIROPRACTIC ARTS CENTER OF MORTON GROVE, P.C.
Entity type:Organization
Organization Name:CHIROPRACTIC ARTS CENTER OF MORTON GROVE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:PINKUS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:847-470-0047
Mailing Address - Street 1:6032 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:MORTON GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60053-2955
Mailing Address - Country:US
Mailing Address - Phone:847-470-0047
Mailing Address - Fax:
Practice Address - Street 1:6032 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:MORTON GROVE
Practice Address - State:IL
Practice Address - Zip Code:60053-2955
Practice Address - Country:US
Practice Address - Phone:847-470-0047
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2018-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-009042111N00000X
IL060-007704261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL596180Medicare PIN