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General NPI Number Information
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NPI Number | 1154262384
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Entity Type | Organization
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Legal Business Name | ELGIN PHYSICAL MEDICINE SC
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Dates
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Enumeration Date | 04/02/2026
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Last Update Date | 04/02/2026
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Provider Practice Location Address
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Address Line | 3617 MORSAY DR
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City | ROCKFORD
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State | IL
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Zip | 61107-4869
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Country | US
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Telephone | 773-278-9525
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Fax | 773-337-9135
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Provider Business Mailing Address
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Address Line | PO BOX 4782
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City | CHICAGO
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State | IL
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Zip | 60680-4782
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Country | US
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Telephone | 773-278-9525
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Fax | 773-337-9135
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Authorized Official
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Title or Position | PRESIDENT
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Name | EUGENE JAO
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Credential |
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Telephone | 773-278-9525
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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 |
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License Number State |
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