| NPI | 1114116522 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JASON G. FENNEMA Owner/President 773-327-2225 |
| Organization Subpart ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IL 038-008864) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070009516) |
| Enumeration Date | 2007-10-22 |
| Last Update Date | 2014-12-30 |