Provider Demographics
NPI:1366600017
Name:NORTHWESTERN PEAK PERFORMANCE HEALTH CARE, LTD
Entity type:Organization
Organization Name:NORTHWESTERN PEAK PERFORMANCE HEALTH CARE, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCROY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-767-3822
Mailing Address - Street 1:6139 W TOUHY AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60646-1268
Mailing Address - Country:US
Mailing Address - Phone:312-440-9646
Mailing Address - Fax:773-767-3944
Practice Address - Street 1:6139 W TOUHY AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60646-1268
Practice Address - Country:US
Practice Address - Phone:312-440-9646
Practice Address - Fax:773-767-3944
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PEAK PERFORMANCE HEALTH CARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-05-29
Last Update Date:2008-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL042619249111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty