Healthcare Provider Details

I. General information

NPI: 1124557269
Provider Name (Legal Business Name): RESPORT CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2017
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1221 NORTH LASALLE DRIVE UNIT 2W
CHICAGO IL
60610-1905
US

IV. Provider business mailing address

1221 NORTH LASALLE DRIVE UNIT 2W
CHICAGO IL
60610-1905
US

V. Phone/Fax

Practice location:
  • Phone: 312-900-2640
  • Fax: 312-588-7242
Mailing address:
  • Phone: 312-900-2640
  • Fax: 312-588-7242

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number038011989
License Number StateIL

VIII. Authorized Official

Name: SEAN COONEY
Title or Position: OWNER
Credential: DC
Phone: 630-209-5259