Provider Demographics
NPI:1548452725
Name:CHIROSPAAAH
Entity type:Organization
Organization Name:CHIROSPAAAH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHERIEKA
Authorized Official - Middle Name:
Authorized Official - Last Name:ADDISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-891-2006
Mailing Address - Street 1:944 EAST 162ND ST.
Mailing Address - Street 2:
Mailing Address - City:SOUTH HOLLAND
Mailing Address - State:IL
Mailing Address - Zip Code:60473
Mailing Address - Country:US
Mailing Address - Phone:708-891-2006
Mailing Address - Fax:708-891-2076
Practice Address - Street 1:944 EAST 162ND ST.
Practice Address - Street 2:
Practice Address - City:SOUTH HOLLAND
Practice Address - State:IL
Practice Address - Zip Code:60473
Practice Address - Country:US
Practice Address - Phone:708-891-2006
Practice Address - Fax:708-891-2076
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1635092OtherBLUE CROSS BLUE SHIELD
IL1632889OtherBLUECROSSBLUE SHIELD
IL364476461Medicaid
IL202059Medicare PIN
IL1635092OtherBLUE CROSS BLUE SHIELD
ILU90751Medicare UPIN
IL1632889OtherBLUECROSSBLUE SHIELD