Provider Demographics
NPI:1013559020
Name:INTEGRATED PHYSICAL MEDICINE OF NAPERVILLE PLLC
Entity Type:Organization
Organization Name:INTEGRATED PHYSICAL MEDICINE OF NAPERVILLE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER/CLINIC DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:POLCYN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:331-249-3999
Mailing Address - Street 1:2155 CITY GATE LN STE 123
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-7733
Mailing Address - Country:US
Mailing Address - Phone:331-249-3999
Mailing Address - Fax:331-249-4029
Practice Address - Street 1:2155 CITY GATE LN STE 123
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-7733
Practice Address - Country:US
Practice Address - Phone:331-249-3999
Practice Address - Fax:331-249-4029
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-10
Last Update Date:2020-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty