Provider Demographics
NPI:1154609360
Name:ADVANCED CHICAGO PHYSICIANS
Entity type:Organization
Organization Name:ADVANCED CHICAGO PHYSICIANS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:V
Authorized Official - Last Name:DIBENEDETTO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:312-671-3693
Mailing Address - Street 1:4045 N. DAMEN AVE.
Mailing Address - Street 2:UNIT #1
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618
Mailing Address - Country:US
Mailing Address - Phone:773-296-2766
Mailing Address - Fax:773-296-2768
Practice Address - Street 1:4045 N. DAMEN AVE.
Practice Address - Street 2:UNIT #1
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618
Practice Address - Country:US
Practice Address - Phone:773-296-2766
Practice Address - Fax:773-296-2768
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-22
Last Update Date:2011-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038009450111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty