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Organization
BLACK CHIROPRACTIC PC
Active
Organization
BLACK CHIROPRACTIC PC
Active
Other names
Black Chiropractic & Family Wellness Center
Organization subpart
No
Provider details
NPI number
Authorized official
CONSTANCE A BLACK D.C. (PRESIDENT)
(847) 328-2008
Entity
Organization
Contact information
Practice address
1609 SHERMAN AVE, 204, EVANSTON, IL 60201-3753
(847) 328-2008
(847) 328-8171
Mailing address
1609 SHERMAN AVE, 204, EVANSTON, IL 60201-3753
(847) 328-2008
(847) 328-8171
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
038003757
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01682433
BLUE CROSS BLUE SHIELD IL
IL
Enumeration date
02/25/2011
Last updated
02/25/2011
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