Provider Demographics
NPI:1699314468
Name:1ST CHOICE CHIROPRACTIC LLC
Entity type:Organization
Organization Name:1ST CHOICE CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:KRISHNAKUMAR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:315-416-8111
Mailing Address - Street 1:131 S STEWART AVE
Mailing Address - Street 2:
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048-2768
Mailing Address - Country:US
Mailing Address - Phone:315-416-8111
Mailing Address - Fax:
Practice Address - Street 1:115 W MAPLE AVE
Practice Address - Street 2:
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-2119
Practice Address - Country:US
Practice Address - Phone:315-416-8111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-27
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty