Healthcare Provider Details

I. General information

NPI: 1992462568
Provider Name (Legal Business Name): NAPERVILLE INJURY CARE & REHAB
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2021
Last Update Date: 11/18/2021
Certification Date: 11/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

445 JACKSON AVE
NAPERVILLE IL
60540-5256
US

IV. Provider business mailing address

445 JACKSON AVE
NAPERVILLE IL
60540-5256
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 Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number
License Number StateNULL

VIII. Authorized Official

Name: KAMBIZ T MAGHSOUDI
Title or Position: OWNER
Credential: DC
Phone: 630-961-1888