| NPI | 1811147846 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LYNNETTE R MCROY Billing Coordinator 773-767-3822 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: IL 042619302) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 042619302) |
| 225400000X Rehabilitation Practitioner (Licence: IL 042619302) | |
| Enumeration Date | 2008-09-26 |
| Last Update Date | 2008-09-26 |