Provider Demographics
NPI:1376616789
Name:LAKE ZURICH PHYSICAL MEDICINE, SC
Entity Type:Organization
Organization Name:LAKE ZURICH PHYSICAL MEDICINE, SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:847-438-3899
Mailing Address - Street 1:450 S RAND RD
Mailing Address - Street 2:
Mailing Address - City:LAKE ZURICH
Mailing Address - State:IL
Mailing Address - Zip Code:60047-2359
Mailing Address - Country:US
Mailing Address - Phone:847-438-3899
Mailing Address - Fax:847-438-5459
Practice Address - Street 1:450 S RAND RD
Practice Address - Street 2:
Practice Address - City:LAKE ZURICH
Practice Address - State:IL
Practice Address - Zip Code:60047-2359
Practice Address - Country:US
Practice Address - Phone:847-438-3899
Practice Address - Fax:847-438-5459
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK10950Medicare ID - Type Unspecified
IL210053Medicare UPIN