Healthcare Provider Details

I. General information

NPI: 1942923776
Provider Name (Legal Business Name): ELGIN PHYSICAL MEDICINE SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2022
Last Update Date: 09/26/2022
Certification Date: 09/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

609 DUNDEE AVE
ELGIN IL
60120-3820
US

IV. Provider business mailing address

PO BOX 4782
CHICAGO IL
60680-4782
US

V. Phone/Fax

Practice location:
  • Phone: 773-278-9525
  • Fax: 773-337-9135
Mailing address:
  • Phone: 773-278-9525
  • Fax: 773-337-9135

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: EUGENE M JAO
Title or Position: PRESIDENT
Credential: MD
Phone: 312-961-6611