Provider Demographics
NPI:1902069909
Name:FAMILY CHIROPRACTIC CLINIC OF BENSENVILLE
Entity type:Organization
Organization Name:FAMILY CHIROPRACTIC CLINIC OF BENSENVILLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MAURICE
Authorized Official - Middle Name:
Authorized Official - Last Name:VELASCO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:630-238-9345
Mailing Address - Street 1:PO BOX 177
Mailing Address - Street 2:
Mailing Address - City:BENSENVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60106-0177
Mailing Address - Country:US
Mailing Address - Phone:630-238-9345
Mailing Address - Fax:630-238-9344
Practice Address - Street 1:165 N CHURCH RD
Practice Address - Street 2:
Practice Address - City:BENSENVILLE
Practice Address - State:IL
Practice Address - Zip Code:60106-2009
Practice Address - Country:US
Practice Address - Phone:630-238-9345
Practice Address - Fax:630-238-9344
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-09
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038007228111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty