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General NPI Number Information
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NPI Number | 1043667199
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Entity Type | Organization
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Legal Business Name | BACK AND NECK PAIN RELIEF OF OAK LAWN
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Dates
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Enumeration Date | 05/18/2016
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Last Update Date | 05/18/2016
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Provider Practice Location Address
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Address Line | 4550 W 103RD ST STE 3B
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City | OAK LAWN
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State | IL
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Zip | 60453-4866
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Country | US
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Telephone | 708-220-0599
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Fax |
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Provider Business Mailing Address
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Address Line | 3619 W 79TH PL
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City | CHICAGO
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State | IL
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Zip | 60652-1801
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Country | US
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Telephone | 708-220-0599
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. MICHAEL FRANCIS MCVADY
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Credential | D.C.
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Telephone | 708-220-0599
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 038009063
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License Number State | IL
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