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General NPI Number Information
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NPI Number | 1205979861
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Entity Type | Organization
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Legal Business Name | HUMAN PERFORMANCE INSTITUTE OF CHICAGO, LLC
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Dates
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Enumeration Date | 02/14/2007
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Last Update Date | 08/02/2011
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Provider Practice Location Address
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Address Line | 1806 W CUYLER AVE
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City | CHICAGO
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State | IL
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Zip | 60613-2402
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Country | US
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Telephone | 773-316-2400
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Fax | 773-751-5292
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Provider Business Mailing Address
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Address Line | 1806 W CUYLER AVE
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City | CHICAGO
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State | IL
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Zip | 60613-2402
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Country | US
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Telephone | 773-316-2400
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Fax | 773-751-5292
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | DR. DANIEL JACOBAZZI
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Credential | D.C., P.T.
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Telephone | 773-316-2400
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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 | 038008864
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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 | 070018357
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License Number State | IL
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