| NPI | 1013335421 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRIAN J RUSSELL President 630-530-0506 |
| Organization Subpart ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IL 038006311) |
| Additional Taxonomies | 111NS0005X Chiropractor, Sports Physician (Licence: IL 038006311) |
| 111NX0800X Chiropractor, Orthopedic (Licence: IL 038006311) | |
| Enumeration Date | 2014-04-02 |
| Last Update Date | 2014-04-02 |