=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265692487
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DX PHYSICAL THERAPY & REHABILITATION, LTD.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/11/2008
-----------------------------------------------------
Last Update Date | 06/11/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7601 W MONTROSE AVE STE. 1
-----------------------------------------------------
City | NORRIDGE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60706-1000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-452-5500
-----------------------------------------------------
Fax | 708-452-5547
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7601 W MONTROSE AVE STE. 1
-----------------------------------------------------
City | NORRIDGE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60706-1000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-452-5500
-----------------------------------------------------
Fax | 708-452-5547
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. PAT FIORE
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 708-452-5500
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 038007070
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------