Provider Demographics
NPI:1942359716
Name:AURORA PHYSICAL MEDICINE
Entity Type:Organization
Organization Name:AURORA PHYSICAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:INAS
Authorized Official - Middle Name:
Authorized Official - Last Name:ELDOUAIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-885-6422
Mailing Address - Street 1:417 S LINCOLNWAY
Mailing Address - Street 2:UNIT B
Mailing Address - City:NORTH AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60542-5109
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:417 S LINCOLNWAY
Practice Address - Street 2:UNIT B
Practice Address - City:NORTH AURORA
Practice Address - State:IL
Practice Address - Zip Code:60542-5109
Practice Address - Country:US
Practice Address - Phone:630-885-6422
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty