Provider Demographics
NPI:1043750938
Name:PHYSICIANS SPORTS AND INJURY CENTER
Entity Type:Organization
Organization Name:PHYSICIANS SPORTS AND INJURY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGERT
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-323-2225
Mailing Address - Street 1:777 OAKMONT LN STE 1000
Mailing Address - Street 2:
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559-5503
Mailing Address - Country:US
Mailing Address - Phone:630-323-2225
Mailing Address - Fax:
Practice Address - Street 1:777 OAKMONT LN STE 1000
Practice Address - Street 2:
Practice Address - City:WESTMONT
Practice Address - State:IL
Practice Address - Zip Code:60559-5503
Practice Address - Country:US
Practice Address - Phone:630-323-2225
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-27
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.013069111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty