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General NPI Number Information
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NPI Number | 1275651242
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Entity Type | Organization
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Legal Business Name | ILLINOIS SPINAL & SPORTS REHABILITATION SC
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Dates
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Enumeration Date | 03/27/2007
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Last Update Date | 08/05/2024
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Provider Practice Location Address
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Address Line | 3360 LACROSSE LN STE 116
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City | NAPERVILLE
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State | IL
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Zip | 60564-8155
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Country | US
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Telephone | 630-904-9700
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Fax | 630-904-9713
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Provider Business Mailing Address
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Address Line | 3360 LACROSSE LN STE 116
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City | NAPERVILLE
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State | IL
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Zip | 60564-8155
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Country | US
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Telephone | 630-904-9700
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Fax | 630-904-9713
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ERIC JAMES LUKOSUS
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Credential | DC
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Telephone | 630-989-9700
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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 | 038008240
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License Number State | IN
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