Healthcare Provider Details

I. General information

NPI: 1609188788
Provider Name (Legal Business Name): COMPREHENSIVE FAMILY HEALTH CENTER, SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2010
Last Update Date: 10/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3973 W ALGONQUIN RD
ALGONQUIN IL
60102-9700
US

IV. Provider business mailing address

PO BOX 200
HAMPSHIRE IL
60140-0200
US

V. Phone/Fax

Practice location:
  • Phone: 847-658-7004
  • Fax: 847-658-7066
Mailing address:
  • Phone: 847-683-0077
  • Fax: 847-683-1022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. DOMINIC JOSEPH RANALLO
Title or Position: DC/OWNER
Credential:
Phone: 847-683-0077