Healthcare Provider Details

I. General information

NPI: 1568524924
Provider Name (Legal Business Name): EXERCISE RX, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 LAKE COOK RD SUITE 120
DEERFIELD IL
60015-5613
US

IV. Provider business mailing address

PO BOX 5979
BUFFALO GROVE IL
60089-5979
US

V. Phone/Fax

Practice location:
  • Phone: 847-498-3736
  • Fax:
Mailing address:
  • Phone: 847-897-5995
  • Fax: 847-897-5990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number
License Number StateIL

VIII. Authorized Official

Name: JEFFREY S MILLER
Title or Position: MEDICAL DIRECTOR
Credential: DN
Phone: 847-498-3736