Provider Demographics
NPI:1457721524
Name:NORTHWEST PHYSICAL MEDICINE
Entity Type:Organization
Organization Name:NORTHWEST PHYSICAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STAYKO
Authorized Official - Middle Name:N
Authorized Official - Last Name:KOLEV
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:847-610-3962
Mailing Address - Street 1:830 E HIGGINS RD
Mailing Address - Street 2:SUITE #111W
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60173-4797
Mailing Address - Country:US
Mailing Address - Phone:847-610-3962
Mailing Address - Fax:
Practice Address - Street 1:830 E HIGGINS RD
Practice Address - Street 2:SUITE #111W
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60173-4797
Practice Address - Country:US
Practice Address - Phone:847-610-3962
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-01
Last Update Date:2015-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038012716111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty