# EVANSTON INTEGRATIVE CHIROPRACTIC CENTER

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1346603156
- **Authorized official:** DR. ARNETRA GILLIAM D.C. (OWNER)
- **Authorized official phone:** (847) 570-0970

## Contact information

- **Practice address:** 708 CHURCH ST, STE. 228, EVANSTON, IL 60201-3875
- **Practice address phone:** (847) 570-0970
- **Practice address fax:** (847) 570-0972
- **Mailing address:** 708 CHURCH ST, STE. 228, EVANSTON, IL 60201-3875
- **Mailing address phone:** (847) 570-0970
- **Mailing address fax:** (847) 570-0972

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 111N00000X | Chiropractor | 038010558 | IL | Yes |

## Other

- **Enumeration date:** 03/30/2016
- **Last updated:** 03/30/2016

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | F300212187 | MEDICARE PTAN | IL |