Provider Demographics
NPI:1487701892
Name:NORTHWEST CHIROPRACTIX INC.
Entity type:Organization
Organization Name:NORTHWEST CHIROPRACTIX INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REHAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:SIDDIQUI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:773-862-3180
Mailing Address - Street 1:3043 W FULLERTON AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-2807
Mailing Address - Country:US
Mailing Address - Phone:773-862-3180
Mailing Address - Fax:773-661-0300
Practice Address - Street 1:3043 W FULLERTON AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-2807
Practice Address - Country:US
Practice Address - Phone:773-862-3180
Practice Address - Fax:773-661-0300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2010-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-008564111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0001622785OtherBCBS PROVIDER #
IL212791Medicare ID - Type UnspecifiedMEDICARE GROUP #