Provider Demographics
NPI:1912379629
Name:CHIROPRACTIC, ACUPUNCTURE AND YOGA CENTER LLC
Entity type:Organization
Organization Name:CHIROPRACTIC, ACUPUNCTURE AND YOGA CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BAHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:AL-SALIHI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:847-400-7598
Mailing Address - Street 1:1625 BARCLAY BLVD
Mailing Address - Street 2:
Mailing Address - City:BUFFALO GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60089-4544
Mailing Address - Country:US
Mailing Address - Phone:847-400-7598
Mailing Address - Fax:
Practice Address - Street 1:1625 BARCLAY BLVD
Practice Address - Street 2:
Practice Address - City:BUFFALO GROVE
Practice Address - State:IL
Practice Address - Zip Code:60089-4544
Practice Address - Country:US
Practice Address - Phone:847-400-7598
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-21
Last Update Date:2015-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-00712111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILIL3317OtherMEDICARE PTAN