Provider Demographics
NPI:1225120462
Name:HANOVER PARK PHYSICAL MEDICINE & REHABILITATION LTD
Entity Type:Organization
Organization Name:HANOVER PARK PHYSICAL MEDICINE & REHABILITATION LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:H
Authorized Official - Last Name:HAYASHI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:630-837-8900
Mailing Address - Street 1:1802 IRVING PARK ROAD
Mailing Address - Street 2:
Mailing Address - City:HANOVER PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60133
Mailing Address - Country:US
Mailing Address - Phone:630-837-8900
Mailing Address - Fax:630-837-8984
Practice Address - Street 1:1802 IRVING PARK ROAD
Practice Address - Street 2:
Practice Address - City:HANOVER PARK
Practice Address - State:IL
Practice Address - Zip Code:60133
Practice Address - Country:US
Practice Address - Phone:630-837-8900
Practice Address - Fax:630-837-8984
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL201173Medicare ID - Type Unspecified