Provider Demographics
NPI:1891011490
Name:MATTHEW PEAHL DC SC
Entity Type:Organization
Organization Name:MATTHEW PEAHL DC SC
Other - Org Name:IIHHS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:PEAHL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:630-809-5254
Mailing Address - Street 1:628 S 3RD ST
Mailing Address - Street 2:
Mailing Address - City:ST CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60174-3909
Mailing Address - Country:US
Mailing Address - Phone:630-809-5254
Mailing Address - Fax:
Practice Address - Street 1:12701 W 143RD ST
Practice Address - Street 2:SUITE 110
Practice Address - City:HOMER GLEN
Practice Address - State:IL
Practice Address - Zip Code:60491-7715
Practice Address - Country:US
Practice Address - Phone:877-694-7722
Practice Address - Fax:815-531-0055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL273Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273Y00000XHospital UnitsRehabilitation Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1649003Medicare PIN