NPIMap

Organization Active NPI

La Clinica SC

  • Chiropractor
  • Chicago, IL
National Provider Identifier
1336504471
Registry record updated Dec 16, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
042620268 Issued in IL
Legal business name
LA CLINICA SC
Practice address
4123 W Fullerton Ave
Chicago, IL 60639-2105
Phone
(773) 278-9525
Fax
(708) 337-9135
NPI assigned
Dec 16, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 16, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Eugene Jao, DC
Title
Owner
Phone
(312) 961-6611

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193200000X MULTI-SPECIALTY GROUP 111N00000X 042620268 IL Primary

Addresses

Primary practice location

4123 W Fullerton Ave
Chicago, IL 60639-2105

Mailing address

PO Box 4782
Chicago, IL 60680-4782
Phone (773) 278-9525

National Provider Directory

National Provider Directory
Tax ID family
La Clinica SC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1450224000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1450224000000",
    "number": "1336504471",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4782",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606804782",
            "telephone_number": "773-278-9525",
            "fax_number": "708-337-9135"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4123 W FULLERTON AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606392105",
            "telephone_number": "773-278-9525",
            "fax_number": "708-337-9135"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LA CLINICA SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-12-16",
        "last_updated": "2015-12-16",
        "status": "A",
        "authorized_official_last_name": "JAO",
        "authorized_official_first_name": "EUGENE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "312-961-6611",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "IL",
            "license": "042620268",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.