Provider Demographics
NPI:1770704496
Name:MCCRANEY FAMILY CHIROPRACTIC
Entity type:Organization
Organization Name:MCCRANEY FAMILY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TANNEIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCRANEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:708-705-7615
Mailing Address - Street 1:6130 ROOSEVELT RD
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60304-2311
Mailing Address - Country:US
Mailing Address - Phone:708-445-7615
Mailing Address - Fax:
Practice Address - Street 1:6130 ROOSEVELT RD
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60304-2311
Practice Address - Country:US
Practice Address - Phone:708-445-7615
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILU84476Medicare UPIN
IL699960Medicare ID - Type Unspecified