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General NPI Number Information
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NPI Number | 1316288392
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Entity Type | Organization
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Legal Business Name | KEMET CHIROPRACTIC & WELLNESS, S.C.
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Dates
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Enumeration Date | 03/15/2013
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Last Update Date | 06/03/2013
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Provider Practice Location Address
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Address Line | 13011 S 104TH AVE 207
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City | PALOS PARK
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State | IL
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Zip | 60464-1506
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Country | US
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Telephone | 847-456-2417
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Fax |
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Provider Business Mailing Address
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Address Line | 13011 S 104TH AVE 207
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City | PALOS PARK
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State | IL
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Zip | 60464-1506
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PROVIDER
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Name | MRS. BROOKLYN WASHINGTON
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Credential | DC
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Telephone | 847-456-2417
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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 | 038012249
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License Number State | IL
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