Organization
ILLINOIS CENTER FOR PROGRESSIVE HEALTH, SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NICHOLAS LEROY DC (PHYSICIAN)
(312) 243-3338
Entity
Organization
Contact information
Practice address
1002 W LAKE ST, CHICAGO, IL 60607-1715
(312) 243-3338
Mailing address
1002 W LAKE ST, CHICAGO, IL 60607-1715
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
038007739
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001607135
BCBS
IL
Enumeration date
01/11/2010
Last updated
05/11/2010
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