Illinois Neuro & Physical Rehabilitation LTD
Organization Active NPI Chiropractor · Wood Dale, IL
NPI 1043570005 · NPPES record last updated May 25, 2012
Key facts
- NPI
- 1043570005
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Chiropractor 111N00000X
- License
- 038006590 (IL)
- Legal business name
- ILLINOIS NEURO & PHYSICAL REHABILITATION LTD
- Practice address
- 199 S Addison Rd
Ste. 105
Wood Dale, IL 60191-1929 - Phone
- (630) 766-1552
- NPI assigned
- May 24, 2012
- Organization subpart
- No
Authorized official
- Name
- Dr. George K. Michalopoulos, D.C.
- Title
- President
- Phone
- (630) 766-1552
Practitioners 13
-
Jerry A Iavarone, D.C.
-
George K. Michalopoulos, D.C.
-
Kara Anne Hoevel, DC
-
Hannah Massey, DC
-
Nathaniel Proce, DC
-
Kayla L Ryan, DC
-
David Traster, DC
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20120731000681 | IL | Part B Supplier - Clinic/Group Practice | 6204092539 |
Receives reassigned benefits from 11 practitioners Practice locations: Wood Dale, IL |
National Provider Directory
Locations
199 S Addison Rd
Ste 105
Wood Dale, IL 60191
Phone (630) 766-1552
199 S Addison Rd
#105106
Wood Dale, IL 60191
Phone (630) 766-1552
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor |
111N00000X | 038006590 | IL | Yes |
Addresses
Primary practice location
199 S Addison Rd
Ste. 105
Wood Dale, IL 60191-1929
Mailing address
199 S Addison Rd
Ste. 105
Wood Dale, IL 60191-1929
Phone (630) 766-1552
Other providers in Wood Dale, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 25, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.