| NPI | 1578977328 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MATTHEW WALKER Manager 312-360-1604 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: IL 036127953) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038012545) |
| 363L00000X Nurse Practitioner (Licence: IL 209011079) | |
| Enumeration Date | 2014-06-19 |
| Last Update Date | 2014-09-15 |