Healthcare Provider Details

I. General information

NPI: 1255691093
Provider Name (Legal Business Name): ELITE REHAB PLAINFIELD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2012
Last Update Date: 08/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15412 S ROUTE 59 SUITE 118
PLAINFIELD IL
60544-2175
US

IV. Provider business mailing address

15412 S ROUTE 59 SUITE 118
PLAINFIELD IL
60544-2175
US

V. Phone/Fax

Practice location:
  • Phone: 815-267-6177
  • Fax: 815-782-7038
Mailing address:
  • Phone: 815-267-6177
  • Fax: 815-782-7038

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. ANTHONY M PIRIE
Title or Position: PRESIDENT
Credential: D.C.
Phone: 815-267-6177