Crystal Lake Medical and Sports Rehab SC

Primary specialty

Sports Physician ChiropractorTaxonomy code 111NS0005X

Legal business name

CRYSTAL LAKE MEDICAL AND SPORTS REHAB SC

Practice address

330 W Terra Cotta Ave
Crystal Lake, IL 60014-3552

Phone

(815) 455-1751

Fax

(815) 455-9450

NPI assigned

Oct 18, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Rodney Vaughn Gabbert, D.C.

Title

Owner

Phone

(815) 455-1751

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161129600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1912088683",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "330 W TERRA COTTA AVE",
            "city": "CRYSTAL LAKE",
            "state": "IL",
            "postal_code": "600143552",
            "telephone_number": "815-455-1751",
            "fax_number": "815-455-9450"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "330 W TERRA COTTA AVE",
            "city": "CRYSTAL LAKE",
            "state": "IL",
            "postal_code": "600143552",
            "telephone_number": "815-455-1751",
            "fax_number": "815-455-9450"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CRYSTAL LAKE MEDICAL AND SPORTS REHAB SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-18",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "GABBERT",
        "authorized_official_first_name": "RODNEY",
        "authorized_official_middle_name": "VAUGHN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "815-455-1751",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111NS0005X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor, Sports Physician",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Crystal Lake Family Dental
• Crystal Lake Family Treatment Center LTD
• Crystal Lake Family Wellness
• Crystal Lake Foot & Ankle Center LLC
• Crystal Lake Immediate Care Physicians LTD.
• Crystal Lake Memory Care, LLC
• Crystal Lake Natural Health Care
• Crystal Lake Ophthalmology Associates PC
• Crystal Lake Optical Inc.
• Crystal Lake Oral Maxillofacial Surgery LTD

• Sports Physician Chiropractor in Crystal Lake, IL
• Providers in Crystal Lake, IL by specialty
• Sports Physician Chiropractor in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.