Provider Demographics
NPI:1649614199
Name:VICTORY REHAB, LLC
Entity type:Organization
Organization Name:VICTORY REHAB, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:KESSLER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:630-857-3704
Mailing Address - Street 1:1300 IROQUOIS AVE
Mailing Address - Street 2:270
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-8553
Mailing Address - Country:US
Mailing Address - Phone:630-857-3704
Mailing Address - Fax:888-891-5022
Practice Address - Street 1:1300 IROQUOIS AVE
Practice Address - Street 2:270
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-8553
Practice Address - Country:US
Practice Address - Phone:630-857-3704
Practice Address - Fax:888-891-5022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-25
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.011320111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL038.011320OtherSTATE LICENSE