| |
12647 S Justine St, Calumet Park, IL 60827-6009 | |
(708) 489-2225 | |
(798) 489-2610 |
Full Name | |
---|---|
Type | Facility |
Speciality | Chiropractor |
Location | 12647 S Justine St, Calumet Park, Illinois |
Accepts Medicare Assignments | Does not participate in Medicare Program. The facility may not accept medicare assignment. |
Identifier | Type | State | Issuer |
---|---|---|---|
1619174653 | NPI | - | NPPES |
01622136 | Other | IL | BLUE CROSSBLUE SHIELD |
038007208 | Medicaid | IL |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
111N00000X | Chiropractor | 038007208 (Illinois) | Primary |
Mailing Address | Practice Location Address |
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12647 S Justine St, Calumet Park, IL 60827-6009 Ph: (708) 489-2225 | 12647 S Justine St, Calumet Park, IL 60827-6009 Ph: (708) 489-2225 |
Dr. Lolita A Wilburn, DC Chiropractor Medicare: Medicare Enrolled Practice Location: 12647 S Justine, Calumet Park, IL 60827 Phone: 708-489-2225 Fax: 708-489-2610 |