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Organization
SOUTHPORT GRACE CHIROPRACTIC AND WELLNESS LLC
Active
Organization
SOUTHPORT GRACE CHIROPRACTIC AND WELLNESS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KEITH OLDING DC (CHIROPRACTOR)
(419) 628-4003
Entity
Organization
Contact information
Practice address
1209 W GRACE ST, CHICAGO, IL 60613-2805
(772) 525-2225
Mailing address
1209 W GRACE ST STE 1, CHICAGO, IL 60613-2805
(772) 525-2225
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
—
—
Other
Enumeration date
03/27/2019
Last updated
05/08/2019
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