Healthcare Provider Details

I. General information

NPI: 1861638991
Provider Name (Legal Business Name): ACCELERATED SPORTS PERFORMANCE CENTERS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2008
Last Update Date: 12/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

195 N HARBOR DR UNIT 2908
CHICAGO IL
60601-7514
US

IV. Provider business mailing address

195 N HARBOR DR UNIT 2908
CHICAGO IL
60601-7514
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number038-009825
License Number StateIL

VIII. Authorized Official

Name: DIVYA J SHARMA
Title or Position: CEO/CHIROPRACTOR
Credential: D.C.
Phone: 312-402-0081