Provider Demographics
NPI:1871232975
Name:SC OSWEGO, INC
Entity Type:Organization
Organization Name:SC OSWEGO, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:D
Authorized Official - Last Name:GLYNN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:630-882-9695
Mailing Address - Street 1:7512 AUDREY AVE
Mailing Address - Street 2:
Mailing Address - City:YORKVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60560-9042
Mailing Address - Country:US
Mailing Address - Phone:630-777-5721
Mailing Address - Fax:
Practice Address - Street 1:1545 DOUGLAS ROAD
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:IL
Practice Address - Zip Code:60543
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:2022-05-27
Last Update Date:2022-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty