Provider Demographics
NPI:1396929980
Name:VERNON HILLS CHIROPRACTIC & REHABILITATION CENTER SC
Entity type:Organization
Organization Name:VERNON HILLS CHIROPRACTIC & REHABILITATION CENTER SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:LEWIS
Authorized Official - Last Name:TALBOT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:847-573-1300
Mailing Address - Street 1:10 W PHILLIP RD
Mailing Address - Street 2:SUITE 114
Mailing Address - City:VERNON HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60061-1799
Mailing Address - Country:US
Mailing Address - Phone:847-573-1300
Mailing Address - Fax:847-247-1333
Practice Address - Street 1:10 W PHILLIP RD
Practice Address - Street 2:SUITE 114
Practice Address - City:VERNON HILLS
Practice Address - State:IL
Practice Address - Zip Code:60061-1799
Practice Address - Country:US
Practice Address - Phone:847-573-1300
Practice Address - Fax:847-247-1333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-19
Last Update Date:2013-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL03009350111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILU85775Medicare UPIN