Provider Demographics
NPI:1396878161
Name:OSWEGO FAMILY CHIROPRACTIC CENTER, P.C.
Entity type:Organization
Organization Name:OSWEGO FAMILY CHIROPRACTIC CENTER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TARA
Authorized Official - Middle Name:L
Authorized Official - Last Name:WORRON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:630-554-9323
Mailing Address - Street 1:1114 DOUGLAS RD
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:IL
Mailing Address - Zip Code:60543-9040
Mailing Address - Country:US
Mailing Address - Phone:630-554-9323
Mailing Address - Fax:630-554-9328
Practice Address - Street 1:1114 DOUGLAS RD
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:IL
Practice Address - Zip Code:60543-9040
Practice Address - Country:US
Practice Address - Phone:630-554-9323
Practice Address - Fax:630-554-9328
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL38008826111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1902804255OtherNPI INDIVIDUAL
ILK15944Medicare ID - Type UnspecifiedPROVIDER NUMBER
ILV04312Medicare UPIN
IL211314Medicare ID - Type UnspecifiedGROUP NUMBER