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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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