Provider Demographics
NPI:1700634904
Name:EBAUGH CHIRO LLC
Entity type:Organization
Organization Name:EBAUGH CHIRO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:EBAUGH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:630-308-0050
Mailing Address - Street 1:1029 CRESTVIEW DR
Mailing Address - Street 2:
Mailing Address - City:LEMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60439-4324
Mailing Address - Country:US
Mailing Address - Phone:630-308-0050
Mailing Address - Fax:
Practice Address - Street 1:1001 75TH ST STE 105
Practice Address - Street 2:
Practice Address - City:WOODRIDGE
Practice Address - State:IL
Practice Address - Zip Code:60517-2608
Practice Address - Country:US
Practice Address - Phone:630-395-7226
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-11
Last Update Date:2024-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty