Provider Demographics
NPI:1619500428
Name:STRETCHCLUB S.C.
Entity Type:Organization
Organization Name:STRETCHCLUB S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMPLOYEE
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:GLYNN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:630-882-9695
Mailing Address - Street 1:332 E VETERANS PKWY
Mailing Address - Street 2:
Mailing Address - City:YORKVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60560-1767
Mailing Address - Country:US
Mailing Address - Phone:630-882-9695
Mailing Address - Fax:
Practice Address - Street 1:332 E VETERANS PKWY
Practice Address - Street 2:
Practice Address - City:YORKVILLE
Practice Address - State:IL
Practice Address - Zip Code:60560-1767
Practice Address - Country:US
Practice Address - Phone:630-882-9695
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-20
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty