Healthcare Provider Details

I. General information

NPI: 1003066010
Provider Name (Legal Business Name): NAPERVILLE REHABILITATION AND PAIN MANAGEMENT CENTER, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2008
Last Update Date: 01/18/2023
Certification Date: 01/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1750 N WASHINGTON ST STE 112C
NAPERVILLE IL
60563-4850
US

IV. Provider business mailing address

1750 N WASHINGTON ST STE 112C
NAPERVILLE IL
60563-4850
US

V. Phone/Fax

Practice location:
  • Phone: 630-961-1888
  • Fax: 773-337-9106
Mailing address:
  • Phone: 630-961-1888
  • Fax: 773-337-9106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038008360
License Number StateIL

VIII. Authorized Official

Name: LYNNETTE R MCROY
Title or Position: BILLING COORDINATOR
Credential:
Phone: 773-767-3822