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Organization
MIDWEST SPORT AND SPINE INC
Active
Organization
MIDWEST SPORT AND SPINE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PHOUKHONG LAMVICHIT DC (OWNER)
(312) 397-1179
Entity
Organization
Contact information
Practice address
730 N FRANKLIN ST, SUITE 602, CHICAGO, IL 60654-3563
(312) 397-1179
(773) 337-9106
Mailing address
730 N FRANKLIN ST, SUITE 602, CHICAGO, IL 60654-3563
(312) 397-1179
(773) 337-9106
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
038012476
IL
Other
Enumeration date
11/21/2015
Last updated
02/07/2020
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