Provider Demographics
NPI:1275966418
Name:RESTORATIVE HEALTH CENTER SC
Entity Type:Organization
Organization Name:RESTORATIVE HEALTH CENTER SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:VENUTI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:847-338-6724
Mailing Address - Street 1:430 BARRON BLVD
Mailing Address - Street 2:
Mailing Address - City:GRAYSLAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60030-1666
Mailing Address - Country:US
Mailing Address - Phone:847-548-4800
Mailing Address - Fax:847-548-4804
Practice Address - Street 1:430 BARRON BLVD
Practice Address - Street 2:
Practice Address - City:GRAYSLAKE
Practice Address - State:IL
Practice Address - Zip Code:60030-1666
Practice Address - Country:US
Practice Address - Phone:847-548-4800
Practice Address - Fax:847-548-4804
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-12
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL042.6200522081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty