Healthcare Provider Details

I. General information

NPI: 1164734307
Provider Name (Legal Business Name): REACT SPINE AND SPORTS INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2010
Last Update Date: 07/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1824 JOHNS DR
GLENVIEW IL
60025
US

IV. Provider business mailing address

1824 JOHNS DR
GLENVIEW IL
60025-1657
US

V. Phone/Fax

Practice location:
  • Phone: 224-432-5276
  • Fax: 224-432-5278
Mailing address:
  • Phone: 224-432-5276
  • Fax: 224-432-5278

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038.011704
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070.017753
License Number StateIL

VIII. Authorized Official

Name: DR. BRIAN C HEALY
Title or Position: PHYSICAL THERAPIST, CHIROPRACTOR
Credential: MPT, DC
Phone: 224-432-5276