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General NPI Number Information
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NPI Number | 1275966418
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Entity Type | Organization
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Legal Business Name | RESTORATIVE HEALTH CENTER SC
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Dates
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Enumeration Date | 08/12/2013
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Last Update Date | 08/12/2013
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Provider Practice Location Address
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Address Line | 430 BARRON BLVD
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City | GRAYSLAKE
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State | IL
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Zip | 60030-1666
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Country | US
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Telephone | 847-548-4800
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Fax | 847-548-4804
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Provider Business Mailing Address
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Address Line | 430 BARRON BLVD
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City | GRAYSLAKE
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State | IL
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Zip | 60030-1666
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Country | US
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Telephone | 847-548-4800
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Fax | 847-548-4804
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. NICHOLAS VENUTI
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Credential | D.C.
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Telephone | 847-338-6724
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | 042.620052
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License Number State | IL
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