Organization
CHICAGO ACCIDENT & INJURY CLINIC LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN GRAY (AGENT)
(224) 778-5140
Entity
Organization
Contact information
Practice address
1150 N STATE ST, SUITE 310, CHICAGO, IL 60610-7481
(224) 778-5140
(877) 575-6373
Mailing address
1150 N STATE ST, SUITE 310, CHICAGO, IL 60610-7481
(224) 778-5140
(877) 575-6373
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
028011350
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11924868
CAQH
—
Enumeration date
08/28/2013
Last updated
08/29/2013
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