Provider Demographics
NPI:1457415531
Name:QUEST FITNESS, LTD.
Entity Type:Organization
Organization Name:QUEST FITNESS, LTD.
Other - Org Name:FITNESS TOGETHER OF WILLOWBROOK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:FRANCIS
Authorized Official - Last Name:DALE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:630-325-7900
Mailing Address - Street 1:555 PLAINFIELD RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:WILLOWBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60527-7602
Mailing Address - Country:US
Mailing Address - Phone:630-325-7900
Mailing Address - Fax:630-325-7940
Practice Address - Street 1:555 PLAINFIELD RD
Practice Address - Street 2:SUITE C
Practice Address - City:WILLOWBROOK
Practice Address - State:IL
Practice Address - Zip Code:60527-7602
Practice Address - Country:US
Practice Address - Phone:630-325-7900
Practice Address - Fax:630-325-7940
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL212803Medicare PIN