Basic Information
| Provider Information | |||||||||
| NPI: | 1568743649 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GOLD STANDARD HEALTHCARE INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1360 N SANDBURG TER | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606102075 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3129444653 | ||||||||
| FaxNumber: | 7733379106 | ||||||||
| Practice Location | |||||||||
| Address1: | 1360 N SANDBURG TER | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606102075 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3129444653 | ||||||||
| FaxNumber: | 7733379106 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/02/2011 | ||||||||
| LastUpdateDate: | 09/02/2011 | ||||||||
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| AuthorizedOfficialLastName: | MCROY | ||||||||
| AuthorizedOfficialFirstName: | LYNNETTE | ||||||||
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| AuthorizedOfficialTitleorPosition: | BILLING COORDINATOR | ||||||||
| AuthorizedOfficialTelephone: | 7737673822 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111N00000X | 038010338 | IL | Y | 193200000X MULTI-SPECIALTY GROUP | Chiropractic Providers | Chiropractor |
No ID Information.