Provider Demographics
NPI:1427121763
Name:SHROBA, JAMES C (DC)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:C
Last Name:SHROBA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4809 W 95TH ST
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-2501
Mailing Address - Country:US
Mailing Address - Phone:708-425-0770
Mailing Address - Fax:708-425-0880
Practice Address - Street 1:4809 W 95TH ST
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-2501
Practice Address - Country:US
Practice Address - Phone:708-425-0770
Practice Address - Fax:708-425-0880
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038007063111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
206493Medicare ID - Type Unspecified
ILU 96131Medicare UPIN