Provider Demographics
NPI:1881808087
Name:WILL COUNTY CHIROPRACTIC & REHAB CENTER, LLC
Entity type:Organization
Organization Name:WILL COUNTY CHIROPRACTIC & REHAB CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:KRAVARIK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:815-609-9081
Mailing Address - Street 1:2400 CATON FARM RD
Mailing Address - Street 2:UNIT K
Mailing Address - City:CREST HILL
Mailing Address - State:IL
Mailing Address - Zip Code:60435-1386
Mailing Address - Country:US
Mailing Address - Phone:815-609-9081
Mailing Address - Fax:815-609-9218
Practice Address - Street 1:2400 CATON FARM RD
Practice Address - Street 2:UNIT K
Practice Address - City:CREST HILL
Practice Address - State:IL
Practice Address - Zip Code:60435-1386
Practice Address - Country:US
Practice Address - Phone:815-609-9081
Practice Address - Fax:815-609-9218
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
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
IL210770Medicare ID - Type UnspecifiedMEDICARE #