Provider Demographics
NPI:1679743900
Name:SUBURBAN CHIROPRACTIC-LANSING, PC
Entity type:Organization
Organization Name:SUBURBAN CHIROPRACTIC-LANSING, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:YODER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:708-418-5505
Mailing Address - Street 1:18525 TORRENCE AVE STE F3
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:IL
Mailing Address - Zip Code:60438-2891
Mailing Address - Country:US
Mailing Address - Phone:708-418-5505
Mailing Address - Fax:708-418-5531
Practice Address - Street 1:18525 TORRENCE AVE STE F3
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:IL
Practice Address - Zip Code:60438-2891
Practice Address - Country:US
Practice Address - Phone:708-418-5505
Practice Address - Fax:708-418-5531
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-03
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-007368261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL21622585OtherBLUE CROSS/BLUE SHIELD
ILU46606Medicare UPIN
IL21622585OtherBLUE CROSS/BLUE SHIELD