Provider Demographics
NPI:1396049771
Name:HILLGROVE FAMILY CHIROPRACTIC
Entity type:Organization
Organization Name:HILLGROVE FAMILY CHIROPRACTIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:POSCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-352-4866
Mailing Address - Street 1:817 W HILLGROVE AVE
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:IL
Mailing Address - Zip Code:60525-5822
Mailing Address - Country:US
Mailing Address - Phone:708-352-4866
Mailing Address - Fax:708-352-1387
Practice Address - Street 1:817 W HILLGROVE AVE
Practice Address - Street 2:
Practice Address - City:LA GRANGE
Practice Address - State:IL
Practice Address - Zip Code:60525-5822
Practice Address - Country:US
Practice Address - Phone:708-352-4866
Practice Address - Fax:708-352-1387
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-29
Last Update Date:2011-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-006294111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1618016OtherBLUE CROSS AND BLUE SHILED OF ILLINOIS
IL921210Medicare UPIN