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General NPI Number Information
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NPI Number | 1417071887
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Entity Type | Organization
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Legal Business Name | PROGRESSIVE PHYSICAL MEDICINE S.C.
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Dates
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Enumeration Date | 03/19/2007
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Last Update Date | 12/06/2007
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Provider Practice Location Address
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Address Line | 426 S MAIN ST
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City | LOMBARD
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State | IL
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Zip | 60148-2600
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Country | US
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Telephone | 630-620-0100
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Fax | 630-620-0101
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Provider Business Mailing Address
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Address Line | 426 S MAIN ST
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City | LOMBARD
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State | IL
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Zip | 60148-2600
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Country | US
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Telephone | 630-620-0100
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Fax | 630-620-0101
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Authorized Official
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Title or Position | CLINIC DIRECTOR, PRESIDENT
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Name | DR. JASON FRIEDMAN
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Credential | D.C.
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Telephone | 630-620-0100
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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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Taxonomy #2
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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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