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General NPI Number Information
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NPI Number | 1134420011
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Entity Type | Organization
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Legal Business Name | BANNOCKBURN CHIROPRACTIC & SPORTS INJURY CENTER PC
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Dates
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Enumeration Date | 11/09/2010
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Last Update Date | 04/18/2018
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Provider Practice Location Address
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Address Line | 2101 WAUKEGAN RD 100
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City | BANNOCKBURN
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State | IL
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Zip | 60015-1836
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Country | US
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Telephone | 847-236-1194
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Fax | 847-236-1195
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Provider Business Mailing Address
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Address Line | 2101 WAUKEGAN RD 100
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City | BANNOCKBURN
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State | IL
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Zip | 60015-1836
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Country | US
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Telephone | 847-236-1194
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Fax | 847-236-1195
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | MR. STUART EVAN YOSS
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Credential | DC
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Telephone | 847-236-1194
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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 | 038.007835
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State |
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