Provider Demographics
NPI:1104980358
Name:PAUL C. ELLSTEIN CHIROPRACTIC PHYSICIANS, S.C.
Entity type:Organization
Organization Name:PAUL C. ELLSTEIN CHIROPRACTIC PHYSICIANS, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:CLIFFORD
Authorized Official - Last Name:ELLSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:708-848-8122
Mailing Address - Street 1:1011 LAKE ST
Mailing Address - Street 2:SUITE 407
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60301-1148
Mailing Address - Country:US
Mailing Address - Phone:708-848-8122
Mailing Address - Fax:708-848-8109
Practice Address - Street 1:1011 LAKE ST
Practice Address - Street 2:SUITE 407
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60301-1148
Practice Address - Country:US
Practice Address - Phone:708-848-8122
Practice Address - Fax:708-848-8109
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-004815111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL31601167OtherBCBS PIN
IL209635Medicare PIN