Healthcare Provider Details

I. General information

NPI: 1841641107
Provider Name (Legal Business Name): PLAINFIELD CHIROPRACTIC AND REHABILITATION, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2016
Last Update Date: 07/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13520 S ROUTE 59 UNIT 100
PLAINFIELD IL
60544-5545
US

IV. Provider business mailing address

13520 S ROUTE 59 UNIT 100
PLAINFIELD IL
60544-5545
US

V. Phone/Fax

Practice location:
  • Phone: 815-439-9800
  • Fax:
Mailing address:
  • Phone: 815-439-9800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038.012972
License Number StateIL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: SANDY HILL
Title or Position: CREDENTIALING
Credential:
Phone: 502-962-2277