Healthcare Provider Details

I. General information

NPI: 1346376241
Provider Name (Legal Business Name): DAVID LOW BACK CENTER DC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 06/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1019 W GALENA AVE
FREEPORT IL
61032-3819
US

IV. Provider business mailing address

1019 W GALENA AVE
FREEPORT IL
61032-3819
US

V. Phone/Fax

Practice location:
  • Phone: 815-232-2225
  • Fax: 815-233-2571
Mailing address:
  • Phone: 815-232-2225
  • Fax: 815-233-2571

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070022643
License Number StateIL

VIII. Authorized Official

Name: PAUL M THEISEN
Title or Position: OWNER
Credential: D.C.
Phone: 815-232-2225