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General NPI Number Information
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NPI Number | 1346231917
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Entity Type | Organization
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Legal Business Name | NAPERVILLE REHAB CLINIC LTD
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Dates
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Enumeration Date | 11/02/2005
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Last Update Date | 10/11/2007
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Provider Practice Location Address
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Address Line | 445 W JACKSON AVE SUITE 102
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City | NAPERVILLE
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State | IL
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Zip | 60540-5256
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Country | US
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Telephone | 630-961-1888
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Fax | 630-961-9555
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Provider Business Mailing Address
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Address Line | 445 W JACKSON AVE SUITE 102
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City | NAPERVILLE
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State | IL
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Zip | 60540-5256
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Country | US
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Telephone | 630-961-1888
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Fax | 630-961-9555
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MICHAEL JAMES MALONEY
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Credential | DC
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Telephone | 630-961-1888
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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 | 04617361
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License Number State | IL
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