Provider Demographics
NPI:1093070567
Name:ST. CHARLES SERVICE CORPORATION
Entity Type:Organization
Organization Name:ST. CHARLES SERVICE CORPORATION
Other - Org Name:OLYMPIA CHIROPRACTIC AND PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:
Authorized Official - First Name:PASQUALE
Authorized Official - Middle Name:G
Authorized Official - Last Name:CALCAGNO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:630-830-8600
Mailing Address - Street 1:260 E. ARMY TRAIL RD,
Mailing Address - Street 2:SUITE D
Mailing Address - City:BARTLETT
Mailing Address - State:IL
Mailing Address - Zip Code:60103-3005
Mailing Address - Country:US
Mailing Address - Phone:630-830-8600
Mailing Address - Fax:630-830-2273
Practice Address - Street 1:1615 W. MAIN STREET
Practice Address - Street 2:
Practice Address - City:ST. CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60174
Practice Address - Country:US
Practice Address - Phone:630-830-8600
Practice Address - Fax:630-830-2273
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-10
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038007980111N00000X
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty