Primal Chiropractic LTD.

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

038012701 Issued in IL

Legal business name

PRIMAL CHIROPRACTIC LTD.

Practice address

12211 S Harlem Ave Ste 1S
Palos Heights, IL 60463-1471

Phone

(708) 671-8082

Fax

(708) 777-4764

NPI assigned

Jun 2, 2015

Organization subpart

No

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

Authorized official

Name

Dr. Ryan Jon Gawron, D.C.

Title

President

Phone

(708) 671-8082

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1433203200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1433203200000",
    "number": "1962882209",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12211 S HARLEM AVE STE 1S",
            "city": "PALOS HEIGHTS",
            "state": "IL",
            "postal_code": "604631471",
            "telephone_number": "708-671-8082",
            "fax_number": "708-777-4764"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12211 S HARLEM AVE STE 1S",
            "city": "PALOS HEIGHTS",
            "state": "IL",
            "postal_code": "604631471",
            "telephone_number": "708-671-8082",
            "fax_number": "708-777-4764"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIMAL CHIROPRACTIC LTD.",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-06-02",
        "last_updated": "2015-06-02",
        "status": "A",
        "authorized_official_last_name": "GAWRON",
        "authorized_official_first_name": "RYAN",
        "authorized_official_middle_name": "JON",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "708-671-8082",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "IL",
            "license": "038012701",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Chiropractor in Palos Heights, IL
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 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.