Healthcare Provider Details

I. General information

NPI: 1508002692
Provider Name (Legal Business Name): ACCELERATED SPORTS PERFORMANCE CENTERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2008
Last Update Date: 12/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2202 N LINCOLN AVE SUITE #2
CHICAGO IL
60614-7170
US

IV. Provider business mailing address

195 N HARBOR DR SUITE #2908
CHICAGO IL
60601-7514
US

V. Phone/Fax

Practice location:
  • Phone: 312-402-0081
  • Fax: 312-552-0010
Mailing address:
  • Phone: 312-402-0081
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. DIVYA SHARMA
Title or Position: PRESIDENT
Credential: DC
Phone: 312-402-0081