Healthcare Provider Details

I. General information

NPI: 1699018093
Provider Name (Legal Business Name): IPM SERVICE COMPANY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2013
Last Update Date: 02/28/2020
Certification Date: 02/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2732 CATON FARM RD
JOLIET IL
60435-1309
US

IV. Provider business mailing address

2732 CATON FARM RD
JOLIET IL
60435-1309
US

V. Phone/Fax

Practice location:
  • Phone: 815-439-2726
  • Fax:
Mailing address:
  • Phone: 815-439-2726
  • Fax: 815-439-2741

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038010557
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. JONATHAN MARK POLCYN
Title or Position: OWNER / PRACTICING PHYSICIAN
Credential: D.C.
Phone: 815-790-3853