Provider Demographics
NPI:1841430808
Name:MDG P.C.
Entity Type:Organization
Organization Name:MDG P.C.
Other - Org Name:SPORTCO REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-820-9500
Mailing Address - Street 1:762 SHORELINE DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60504-6108
Mailing Address - Country:US
Mailing Address - Phone:630-820-9500
Mailing Address - Fax:630-820-9504
Practice Address - Street 1:83 TEMPLETON DR
Practice Address - Street 2:UNIT C
Practice Address - City:OSWEGO
Practice Address - State:IL
Practice Address - Zip Code:60543-7019
Practice Address - Country:US
Practice Address - Phone:630-554-9991
Practice Address - Fax:630-554-9992
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-03
Last Update Date:2009-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038008664111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty