Provider Demographics
NPI:1427247147
Name:ADVANCED CENTER FOR HEALTH & PAIN MANAGEMENT
Entity type:Organization
Organization Name:ADVANCED CENTER FOR HEALTH & PAIN MANAGEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NAPRAPATH
Authorized Official - Prefix:DR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:CICHOWICZ
Authorized Official - Suffix:
Authorized Official - Credentials:DN
Authorized Official - Phone:630-833-4007
Mailing Address - Street 1:3602 S 61ST AVE
Mailing Address - Street 2:
Mailing Address - City:CICERO
Mailing Address - State:IL
Mailing Address - Zip Code:60804-4146
Mailing Address - Country:US
Mailing Address - Phone:630-833-4007
Mailing Address - Fax:630-941-1608
Practice Address - Street 1:3602 S 61ST AVE
Practice Address - Street 2:
Practice Address - City:CICERO
Practice Address - State:IL
Practice Address - Zip Code:60804-4146
Practice Address - Country:US
Practice Address - Phone:630-833-4007
Practice Address - Fax:630-941-1608
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-18
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN0400XChiropractic ProvidersChiropractorNeurologyGroup - Multi-Specialty