Provider Demographics
NPI:1720123797
Name:CHICAGO NEUROSCIENCE INSTITUTE, LTD
Entity type:Organization
Organization Name:CHICAGO NEUROSCIENCE INSTITUTE, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:H
Authorized Official - Last Name:DURRANT
Authorized Official - Suffix:
Authorized Official - Credentials:DC, PHD
Authorized Official - Phone:847-888-1811
Mailing Address - Street 1:1795 GRANDSTAND PL
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123-4980
Mailing Address - Country:US
Mailing Address - Phone:847-888-1811
Mailing Address - Fax:847-888-1868
Practice Address - Street 1:1795 GRANDSTAND PL
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-4980
Practice Address - Country:US
Practice Address - Phone:847-888-1811
Practice Address - Fax:847-888-1868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-004673111N00000X
111N00000X, 111NN0400X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN0400XChiropractic ProvidersChiropractorNeurologyGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL4532387OtherBLUE CROSS BLUE SHIELD
ILT37893Medicare UPIN
IL213002Medicare ID - Type Unspecified