| NPI | 1477758092 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA MARIE RUBIS Doctor 815-207-7463 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation Pain Medicine (Licence: IL 036078826) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038010952) |
| 122300000X Dentist | |
| Enumeration Date | 2007-06-15 |
| Last Update Date | 2021-03-02 |