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General NPI Number Information
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NPI Number | 1437435807
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Entity Type | Organization
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Legal Business Name | SUBURBAN X-RAY, LTD
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Dates
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Enumeration Date | 10/28/2011
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Last Update Date | 10/28/2011
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Provider Practice Location Address
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Address Line | 3113 CALWAGNER ST
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City | FRANKLIN PARK
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State | IL
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Zip | 60131-2622
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Country | US
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Telephone | 630-529-0077
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Fax |
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Provider Business Mailing Address
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Address Line | 7N315 SYCAMORE AVE
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City | MEDINAH
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State | IL
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Zip | 60157-9799
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Country | US
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Telephone | 630-529-0077
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Fax | 630-529-0087
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Authorized Official
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Title or Position | PRESIDENT
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Name | PAMELA A BALLARD
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Credential | DC
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Telephone | 630-529-0077
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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 | 060-006504
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License Number State | IL
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