Provider Demographics
NPI:1861057887
Name:CROSS-UP CHIROPRACTIC, LTD
Entity type:Organization
Organization Name:CROSS-UP CHIROPRACTIC, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:RIEKE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:847-984-2702
Mailing Address - Street 1:1025 W PARK AVE
Mailing Address - Street 2:
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048-2550
Mailing Address - Country:US
Mailing Address - Phone:847-984-2702
Mailing Address - Fax:847-984-2786
Practice Address - Street 1:1025 W PARK AVE
Practice Address - Street 2:
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-2550
Practice Address - Country:US
Practice Address - Phone:847-984-2702
Practice Address - Fax:847-984-2786
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-06
Last Update Date:2019-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty