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General NPI Number Information
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NPI Number | 1265021067
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Entity Type | Organization
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Legal Business Name | INJURY CENTERS OF ILLINOIS
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Dates
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Enumeration Date | 01/15/2021
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Last Update Date | 01/15/2021
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Provider Practice Location Address
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Address Line | 1604 SIBLEY BLVD
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City | CALUMET CITY
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State | IL
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Zip | 60409-2231
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Country | US
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Telephone | 708-360-3258
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Fax |
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Provider Business Mailing Address
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Address Line | 1604 SIBLEY BLVD
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City | CALUMET CITY
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State | IL
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Zip | 60409-2231
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Country | US
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Telephone | 708-360-3258
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | THOMAS P DZIELAWSKI
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Credential | DC
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Telephone | 773-969-4777
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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