Healthcare Provider Details

I. General information

NPI: 1629397310
Provider Name (Legal Business Name): UNIVERSAL PAIN AND WELLNESS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2010
Last Update Date: 06/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 W ARMY TRAIL BLVD SUITE A
ADDISON IL
60101-3299
US

IV. Provider business mailing address

601 W ARMY TRAIL BLVD SUITE A
ADDISON IL
60101-3299
US

V. Phone/Fax

Practice location:
  • Phone: 630-543-1929
  • Fax: 630-543-1931
Mailing address:
  • Phone: 630-543-1929
  • Fax: 630-543-1931

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038011060
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070016639
License Number StateIL

VIII. Authorized Official

Name: DR. SCOTT B ECKELBARGER
Title or Position: PRESIDENT
Credential: D.C.
Phone: 630-543-1929