Chicago Anti Aging Institute SC
Organization Active NPI Sports Medicine (Neuromusculoskeletal Medicine) Physician · Lockport, IL
NPI 1003376245 · NPPES record last updated Mar 22, 2019
Key facts
- NPI
- 1003376245
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Sports Medicine (Neuromusculoskeletal Medicine) Physician 204C00000X
- Legal business name
- CHICAGO ANTI AGING INSTITUTE SC
- Practice address
- 16622 W 159TH St Ste 500
Lockport, IL 60441-8015 - Phone
- (815) 838-7746
- Fax
- (815) 838-5090
- NPI assigned
- Mar 22, 2019
- Organization subpart
- No
Authorized official
- Name
- Dr. Loren Davis, DC
- Title
- President
- Phone
- (708) 267-2164
Practitioners 4
-
Loren Davis, D.C.
-
Carleen Kaucky, C-NP
-
Atul Joshi, D.O.
-
Karen Ellen Wiemer X, MASSAGE THERAPIST
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20190724000691 | IL | Part B Supplier - Clinic/Group Practice | 7113253576 |
Receives reassigned benefits from 3 practitioners Practice locations: Lockport, IL |
National Provider Directory
Locations
16622 W 159th St
Ste 500
Lockport, IL 60441
Phone (815) 838-7746
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Sports Medicine (Neuromusculoskeletal Medicine) Physician |
204C00000X | Yes |
Addresses
Primary practice location
16622 W 159TH St Ste 500
Lockport, IL 60441-8015
Mailing address
16622 W 159TH St Ste 500
Lockport, IL 60441-8015
Phone (815) 838-7746
Other names
- Chicago Anti Aging Institute
Other providers in Lockport, IL
- Monica Cella
- Sharon Moncy Chacko
- Chatterpillar Pediatric Therapy
- Yasmin Chavez
- Denny Cheung
- Chicago Spine Institute PC
- Jill Chokshi
- Karen L. Cicirale
- Tracey L. Cicirale
- Jacqueline Cikowski
All providers in Lockport, IL · Sports Medicine (Neuromusculoskeletal Medicine) Physician in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 22, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.