# CHICAGO ANTI AGING INSTITUTE SC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Chicago Anti Aging Institute
- **Organization subpart:** No

## Provider details

- **NPI number:** 1003376245
- **Authorized official:** DR. LOREN DAVIS DC (PRESIDENT)
- **Authorized official phone:** (708) 267-2164

## Contact information

- **Practice address:** 16622 W 159TH ST STE 500, LOCKPORT, IL 60441-8015
- **Practice address phone:** (815) 838-7746
- **Practice address fax:** (815) 838-5090
- **Mailing address:** 16622 W 159TH ST STE 500, LOCKPORT, IL 60441-8015
- **Mailing address phone:** (815) 838-7746
- **Mailing address fax:** (815) 838-5090

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 204C00000X | Sports Medicine (Neuromusculoskeletal Medicine) Physician | — | NULL | Yes |
| 204C00000X | Sports Medicine (Neuromusculoskeletal Medicine) Physician | — | — | Yes |

## Other

- **Enumeration date:** 03/22/2019
- **Last updated:** 03/22/2019