Provider Demographics
NPI:1962667501
Name:AMHERST CHIROPRACTIC & REHABILITATION GROUP
Entity Type:Organization
Organization Name:AMHERST CHIROPRACTIC & REHABILITATION GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:A
Authorized Official - Last Name:YOUNIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:224-848-0165
Mailing Address - Street 1:14044 PALISADES AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTLEY
Mailing Address - State:IL
Mailing Address - Zip Code:60142-7891
Mailing Address - Country:US
Mailing Address - Phone:224-848-0165
Mailing Address - Fax:847-550-4096
Practice Address - Street 1:14044 PALISADES AVE
Practice Address - Street 2:
Practice Address - City:HUNTLEY
Practice Address - State:IL
Practice Address - Zip Code:60142
Practice Address - Country:US
Practice Address - Phone:224-848-0165
Practice Address - Fax:847-550-4096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-23
Last Update Date:2018-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-005434111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK49717Medicare PIN