Healthcare Provider Details

I. General information

NPI: 1467585703
Provider Name (Legal Business Name): FIMREITE CHIROPRACTIC, S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 11/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4727 WILLOW SPRINGS RD
LA GRANGE IL
60525-6140
US

IV. Provider business mailing address

4727 WILLOW SPRINGS RD
LA GRANGE IL
60525-6140
US

V. Phone/Fax

Practice location:
  • Phone: 708-352-3352
  • Fax:
Mailing address:
  • Phone: 708-352-3352
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. GORDON K. FIMREITE
Title or Position: PRESIDENT
Credential: D.C.
Phone: 708-352-3352