| NPI | 1275772154 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHRISTOPHER SCOTT CHALK President 815-986-4411 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: IL 036097622) |
| Additional Taxonomies | 261Q00000X Clinic/Center (Licence: IL 038006422) |
| 111NS0005X Chiropractor Sports Physician (Licence: IL 038006422) | |
| Enumeration Date | 2009-02-17 |
| Last Update Date | 2010-10-11 |