Provider Demographics
NPI:1043570005
Name:ILLINOIS NEURO & PHYSICAL REHABILITATION LTD
Entity Type:Organization
Organization Name:ILLINOIS NEURO & PHYSICAL REHABILITATION LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:K
Authorized Official - Last Name:MICHALOPOULOS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:630-766-1552
Mailing Address - Street 1:199 S ADDISON RD
Mailing Address - Street 2:STE. 105
Mailing Address - City:WOOD DALE
Mailing Address - State:IL
Mailing Address - Zip Code:60191-1929
Mailing Address - Country:US
Mailing Address - Phone:630-766-1552
Mailing Address - Fax:
Practice Address - Street 1:199 S ADDISON RD
Practice Address - Street 2:STE. 105
Practice Address - City:WOOD DALE
Practice Address - State:IL
Practice Address - Zip Code:60191-1929
Practice Address - Country:US
Practice Address - Phone:630-766-1552
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-24
Last Update Date:2012-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038006590111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty