Healthcare Provider Details

I. General information

NPI: 1922132703
Provider Name (Legal Business Name): RIVERVIEW CHIROPRACTIC AND WELLNESS CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14722 S. NAPERVILLE RD UNIT 100
PLAINFIELD IL
60544
US

IV. Provider business mailing address

14722 S. NAPERVILLE RD UNIT 100
PLAINFIELD IL
60544
US

V. Phone/Fax

Practice location:
  • Phone: 815-254-9141
  • Fax: 815-254-9184
Mailing address:
  • Phone: 815-254-9141
  • Fax: 815-254-9184

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038-008648
License Number StateIL

VII. Legacy identifiers

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

# 1
Identifier02226022
Identifier TypeOTHER
Identifier StateIL
Identifier IssuerBCBS OF IL

VIII. Authorized Official

Name: DR. FREDERIC JUDE RATIO
Title or Position: PRESIDENT
Credential: DC
Phone: 815-254-9141