Healthcare Provider Details

I. General information

NPI: 1407853393
Provider Name (Legal Business Name): ADDISON PHYSICAL MEDICINE AND REHABILITATION CENTER LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

199 S. ADDISON RD. SUITE #106
WOOD DALE IL
60191-1534
US

IV. Provider business mailing address

199 S. ADDISON RD. SUITE #106
WOOD DALE IL
60191-1534
US

V. Phone/Fax

Practice location:
  • Phone: 630-766-1552
  • Fax: 630-766-4220
Mailing address:
  • Phone: 630-766-1552
  • Fax: 630-766-4220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038008124
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number StateIL

VIII. Authorized Official

Name: DR. EDWARD MICHAEL KRYS
Title or Position: OWNER
Credential: D.C.
Phone: 630-766-1552