Provider Demographics
NPI:1528237294
Name:LANDGREBE CHIROPRACTIC P.C.
Entity type:Organization
Organization Name:LANDGREBE CHIROPRACTIC P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:LANDGREBE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:269-861-1789
Mailing Address - Street 1:6828 171ST ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60477-3724
Mailing Address - Country:US
Mailing Address - Phone:708-429-4332
Mailing Address - Fax:
Practice Address - Street 1:6828 171ST ST
Practice Address - Street 2:SUITE B
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60477-3724
Practice Address - Country:US
Practice Address - Phone:708-429-4332
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-26
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center