Provider Demographics
NPI:1699066167
Name:WHITE LOTUS CHIROPRACTIC OF OAK PARK LTD
Entity type:Organization
Organization Name:WHITE LOTUS CHIROPRACTIC OF OAK PARK LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC, PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TARA
Authorized Official - Middle Name:D
Authorized Official - Last Name:GEROU
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:708-383-1200
Mailing Address - Street 1:1001 MADISON ST
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60302-4443
Mailing Address - Country:US
Mailing Address - Phone:708-383-1200
Mailing Address - Fax:708-383-3630
Practice Address - Street 1:1001 MADISON ST
Practice Address - Street 2:1ST FLOOR
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60302-4443
Practice Address - Country:US
Practice Address - Phone:708-383-1200
Practice Address - Fax:708-383-3630
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-02
Last Update Date:2011-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038011866111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty