Organization
EVANSTON INTEGRATIVE CHIROPRACTIC CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ARNETRA GILLIAM D.C. (OWNER)
(847) 570-0970
Entity
Organization
Contact information
Practice address
708 CHURCH ST, STE. 228, EVANSTON, IL 60201-3875
(847) 570-0970
(847) 570-0972
Mailing address
708 CHURCH ST, STE. 228, EVANSTON, IL 60201-3875
(847) 570-0970
(847) 570-0972
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
038010558
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
F300212187
MEDICARE PTAN
IL
Enumeration date
03/30/2016
Last updated
03/30/2016
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