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General NPI Number Information
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NPI Number | 1285796680
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Entity Type | Organization
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Legal Business Name | PHYSICIANS SPORTS & INJURY CENTER, INC
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Dates
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Enumeration Date | 12/14/2006
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Last Update Date | 02/04/2010
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Provider Practice Location Address
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Address Line | 777 OAKMONT LN SUITE 1000
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City | WESTMONT
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State | IL
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Zip | 60559-5511
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Country | US
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Telephone | 630-323-2225
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Fax | 630-323-5230
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Provider Business Mailing Address
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Address Line | 777 OAKMONT LN SUITE 1000
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City | WESTMONT
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State | IL
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Zip | 60559-5511
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Country | US
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Telephone | 630-323-2225
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Fax | 630-323-5230
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DARRELL WEHREND
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Credential | DC
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Telephone | 630-323-2225
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NR0400X
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Taxonomy Name | Rehabilitation Chiropractor
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License Number | 038008598
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License Number State | IL
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