Provider Demographics
NPI:1184814998
Name:COMPREHENSIVE MEDICAL REHABILITION INC
Entity Type:Organization
Organization Name:COMPREHENSIVE MEDICAL REHABILITION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CATHY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:DZIK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:815-986-4411
Mailing Address - Street 1:1820 WINDSOR RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:LOVES PARK
Mailing Address - State:IL
Mailing Address - Zip Code:61111-4271
Mailing Address - Country:US
Mailing Address - Phone:815-986-4411
Mailing Address - Fax:815-986-4414
Practice Address - Street 1:1820 WINDSOR RD
Practice Address - Street 2:SUITE A
Practice Address - City:LOVES PARK
Practice Address - State:IL
Practice Address - Zip Code:61111-4271
Practice Address - Country:US
Practice Address - Phone:815-986-4411
Practice Address - Fax:815-986-4414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-27
Last Update Date:2015-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-009050111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL10132132OtherBCBS NUMBER
IL1417921610OtherPERSONAL NPI NUMBER
IL10132132OtherBCBS NUMBER
ILK09539Medicare PIN