Provider Demographics
NPI:1871361048
Name:SJ CHIROPRACTIC LLC
Entity type:Organization
Organization Name:SJ CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SIMONE
Authorized Official - Middle Name:J
Authorized Official - Last Name:JOSEPH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:708-848-2730
Mailing Address - Street 1:715 LAKE ST STE 271
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60301-1411
Mailing Address - Country:US
Mailing Address - Phone:708-848-2730
Mailing Address - Fax:708-848-2739
Practice Address - Street 1:715 LAKE ST STE 271
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60301-1411
Practice Address - Country:US
Practice Address - Phone:708-848-2730
Practice Address - Fax:708-848-2739
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-18
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty