Provider Demographics
NPI:1417071887
Name:PROGRESSIVE PHYSICAL MEDICINE S.C.
Entity Type:Organization
Organization Name:PROGRESSIVE PHYSICAL MEDICINE S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR, PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:FRIEDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:630-620-0100
Mailing Address - Street 1:426 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-2600
Mailing Address - Country:US
Mailing Address - Phone:630-620-0100
Mailing Address - Fax:630-620-0101
Practice Address - Street 1:426 S MAIN ST
Practice Address - Street 2:
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-2600
Practice Address - Country:US
Practice Address - Phone:630-620-0100
Practice Address - Fax:630-620-0101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty