| NPI | 1285687087 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WENDY NEWMAN Comptroller 815-227-9900 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036037810) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038010413) |
| 225100000X Physical Therapist (Licence: IL 070014686) | |
| Enumeration Date | 2006-05-19 |
| Last Update Date | 2020-08-22 |