Provider Demographics
NPI:1366517377
Name:BUFFALO GROVE CHIROPRACTIC CENTER, LTD
Entity type:Organization
Organization Name:BUFFALO GROVE CHIROPRACTIC CENTER, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GLASKIN-CLAY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:847-276-2868
Mailing Address - Street 1:1411 MCHENRY RD
Mailing Address - Street 2:SUITE 225
Mailing Address - City:BUFFALO GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60089-1385
Mailing Address - Country:US
Mailing Address - Phone:847-276-2868
Mailing Address - Fax:847-276-2783
Practice Address - Street 1:1411 MCHENRY RD
Practice Address - Street 2:SUITE 225
Practice Address - City:BUFFALO GROVE
Practice Address - State:IL
Practice Address - Zip Code:60089-1385
Practice Address - Country:US
Practice Address - Phone:847-276-2868
Practice Address - Fax:847-276-2783
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL38008989111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty