Healthcare Provider Details

I. General information

NPI: 1891011490
Provider Name (Legal Business Name): MATTHEW PEAHL DC SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2010
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12701 W 143RD ST SUITE 110
HOMER GLEN IL
60491-7715
US

IV. Provider business mailing address

628 S 3RD ST
ST CHARLES IL
60174-3909
US

V. Phone/Fax

Practice location:
  • Phone: 877-694-7722
  • Fax: 815-531-0055
Mailing address:
  • Phone: 630-809-5254
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code273Y00000X
TaxonomyRehabilitation Hospital Unit
License Number
License Number StateIL

VIII. Authorized Official

Name: DR. MATTHEW DAVID PEAHL
Title or Position: PRESIDENT
Credential: DC
Phone: 630-809-5254