Provider Demographics
NPI:1063253276
Name:THE DOC OF WEST LOOP PLLC
Entity type:Organization
Organization Name:THE DOC OF WEST LOOP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:KAMAL
Authorized Official - Middle Name:
Authorized Official - Last Name:VAID
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:847-217-4697
Mailing Address - Street 1:6600 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:MORTON GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60053-1424
Mailing Address - Country:US
Mailing Address - Phone:847-217-4697
Mailing Address - Fax:
Practice Address - Street 1:1144 W RANDOLPH ST STE 2
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-1619
Practice Address - Country:US
Practice Address - Phone:847-217-4697
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-03
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty