Provider Demographics
NPI:1538344593
Name:BASKIN CHIROPRACTIC
Entity type:Organization
Organization Name:BASKIN CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:COSHUN
Authorized Official - Middle Name:
Authorized Official - Last Name:BASKIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:708-466-5535
Mailing Address - Street 1:3610 W. 212TH PLACE
Mailing Address - Street 2:
Mailing Address - City:MATTESON
Mailing Address - State:IL
Mailing Address - Zip Code:60443
Mailing Address - Country:US
Mailing Address - Phone:708-466-5535
Mailing Address - Fax:
Practice Address - Street 1:3330 W. 177TH STREET 1E
Practice Address - Street 2:
Practice Address - City:HAZEL CREST
Practice Address - State:IL
Practice Address - Zip Code:60429
Practice Address - Country:US
Practice Address - Phone:708-466-5535
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-08
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038010990261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL215754Medicare PIN
ILK50261Medicare UPIN