Provider Demographics
NPI:1992896203
Name:CHISLOF, IRA SCOTT (DC)
Entity type:Individual
Prefix:DR
First Name:IRA
Middle Name:SCOTT
Last Name:CHISLOF
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7329 N HARLEM AVENE
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:IL
Mailing Address - Zip Code:60714-4252
Mailing Address - Country:US
Mailing Address - Phone:847-588-0800
Mailing Address - Fax:847-588-8011
Practice Address - Street 1:7329 N HARLEM AVE
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:IL
Practice Address - Zip Code:60714-4252
Practice Address - Country:US
Practice Address - Phone:847-588-0800
Practice Address - Fax:847-588-8011
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038004506111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL680870Medicare ID - Type Unspecified
ILT37790Medicare UPIN