Healthcare Provider Details

I. General information

NPI: 1427360130
Provider Name (Legal Business Name): ELITE REHABILITAION INSTITUE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

24457 W EAMES ST
CHANNAHON IL
60410-5591
US

IV. Provider business mailing address

24457 W EAMES ST
CHANNAHON IL
60410-5591
US

V. Phone/Fax

Practice location:
  • Phone: 815-724-0835
  • Fax: 815-724-0845
Mailing address:
  • Phone: 815-724-0835
  • Fax: 815-724-0845

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038009041
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070013955
License Number StateIL

VIII. Authorized Official

Name: DR. ANTHONY M PIRIE
Title or Position: MEMBER
Credential: D.C.
Phone: 815-724-0835