Provider Demographics
NPI:1255402244
Name:BALANCE CENTERS OF ILLINOIS, LLC
Entity type:Organization
Organization Name:BALANCE CENTERS OF ILLINOIS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:K
Authorized Official - Last Name:BUSKIRK
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:847-906-2022
Mailing Address - Street 1:PO BOX 4733
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-4733
Mailing Address - Country:US
Mailing Address - Phone:847-679-0629
Mailing Address - Fax:847-679-0630
Practice Address - Street 1:3545 LAKE AVE
Practice Address - Street 2:#103
Practice Address - City:WILMETTE
Practice Address - State:IL
Practice Address - Zip Code:60091-1058
Practice Address - Country:US
Practice Address - Phone:847-906-2021
Practice Address - Fax:847-512-5064
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2008-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL060004284225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209881OtherGROUP MEDICARE
IL01634372OtherBLUE SHIELD