Provider Demographics
NPI:1942923776
Name:ELGIN PHYSICAL MEDICINE SC
Entity Type:Organization
Organization Name:ELGIN PHYSICAL MEDICINE SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:M
Authorized Official - Last Name:JAO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-961-6611
Mailing Address - Street 1:PO BOX 4782
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60680-4782
Mailing Address - Country:US
Mailing Address - Phone:773-278-9525
Mailing Address - Fax:773-337-9135
Practice Address - Street 1:609 DUNDEE AVE
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60120-3820
Practice Address - Country:US
Practice Address - Phone:773-278-9525
Practice Address - Fax:773-337-9135
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-26
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty