Hyde Park Chiropractic Wellness Center Sc

Chiropractor in Chicago, IL. Organization (NPI-2).

NPI number1104926344

StatusActive

Last updated in NPPESJan 11, 2023

Details

NPI: 1104926344
Entity type: Organization (NPI-2)
Legal business name: Hyde Park Chiropractic Wellness Center Sc
Organization subpart: No
Enumeration date: Sep 25, 2006
Certification date: Jan 11, 2023
Last updated: Jan 11, 2023

Medicare and OIG

Medicare enrolled (PECOS): Yes · PART B SUPPLIER - CLINIC/GROUP PRACTICE
Can order and refer: Not on the CMS order and referring list
OIG exclusion list: This NPI is not listed

CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check

Taxonomy and licenses

Taxonomy code	Description	License	State	Primary
111N00000X	Chiropractor	038007681	IL	Yes

Practice location

1304 E 47th St Ste 201
Chicago, IL 60653-4695

Phone 773-493-7034 · Fax 773-493-5521

Mailing address

1304 E 47th St Ste 201
Chicago, IL 60653-4695

Phone 773-493-7034 · Fax 773-493-5521

Authorized official

Rolande D Balan
Owner
7734937034

Is something wrong?

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