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Organization
MICHIGAN AVE CHIROPRACTIC AND WELLNESS
Active
Organization
MICHIGAN AVE CHIROPRACTIC AND WELLNESS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THOMAS BLAKE KIVISTO DC (OWNER)
(312) 274-0711
Entity
Organization
Contact information
Practice address
875 N MICHIGAN AVE STE 2519, CHICAGO, IL 60611-1803
(312) 274-0711
Mailing address
875 N MICHIGAN AVE STE 2519, CHICAGO, IL 60611-1803
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
038012401
IL
Other
Enumeration date
11/20/2013
Last updated
11/20/2013
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