Provider Demographics
NPI:1154584761
Name:PHYSICIAN HEALTH SERVICES INC
Entity type:Organization
Organization Name:PHYSICIAN HEALTH SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN
Authorized Official - Prefix:
Authorized Official - First Name:G
Authorized Official - Middle Name:OZIN
Authorized Official - Last Name:IROWA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:773-918-1919
Mailing Address - Street 1:7959 S WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60620-5941
Mailing Address - Country:US
Mailing Address - Phone:773-918-1919
Mailing Address - Fax:773-918-1978
Practice Address - Street 1:7959 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60620-5941
Practice Address - Country:US
Practice Address - Phone:773-918-1919
Practice Address - Fax:773-918-1978
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-03
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038003633111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty