| NPI | 1356754592 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | REBECCA ANN ROSENTHAL Chiropractor 815-776-0595 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: IL 038011927) |
| Additional Taxonomies | 302F00000X Exclusive Provider Organization (Licence: IA 007243) |
| 302F00000X Exclusive Provider Organization (Licence: WI 4551012) | |
| Enumeration Date | 2014-06-05 |
| Last Update Date | 2014-06-05 |