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Organization
OLD IRVING CHIROPRACTIC & WELLNESS CENTER, LLC
Active
Organization
OLD IRVING CHIROPRACTIC & WELLNESS CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAPHNE ROSCOE D.C. (CHIROPRACTOR)
(713) 410-3776
Entity
Organization
Contact information
Practice address
4337 W IRVING PARK RD, CHICAGO, IL 60641-2830
(713) 410-3776
Mailing address
4337 W IRVING PARK RD, CHICAGO, IL 60641-2830
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
038-010362
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11628176
CAQH
IL
Enumeration date
02/14/2008
Last updated
06/16/2008
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