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General NPI Number Information
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NPI Number | 1316052079
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Entity Type | Organization
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Legal Business Name | OMEGA SPINE REHAB SC
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Dates
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Enumeration Date | 08/20/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 9346 WAUKEGAN RD
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City | MORTON GROVE
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State | IL
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Zip | 60053
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Country | US
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Telephone | 847-967-8899
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Fax | 847-967-1980
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Provider Business Mailing Address
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Address Line | 9346 WAUKEGAN RD
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City | MORTON GROVE
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State | IL
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Zip | 60053
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Country | US
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Telephone | 847-967-8899
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Fax | 847-967-1980
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. LARRY YUN
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Credential | DC
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Telephone | 847-967-8899
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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 |
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License Number State | IL
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