Provider Demographics
NPI:1073658985
Name:DR LORI PORTNOY INC
Entity type:Organization
Organization Name:DR LORI PORTNOY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:E
Authorized Official - Last Name:PORTNOY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:773-248-2323
Mailing Address - Street 1:954 W ARMINTAGE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614
Mailing Address - Country:US
Mailing Address - Phone:773-248-2323
Mailing Address - Fax:773-248-2359
Practice Address - Street 1:954 W ARMINTAGE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614
Practice Address - Country:US
Practice Address - Phone:773-248-2323
Practice Address - Fax:773-248-2329
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1682607OtherBCBS
IL1682607OtherBCBS