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General NPI Number Information
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NPI Number | 1467585703
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Entity Type | Organization
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Legal Business Name | FIMREITE CHIROPRACTIC, S.C.
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Dates
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Enumeration Date | 03/14/2007
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Last Update Date | 11/05/2007
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Provider Practice Location Address
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Address Line | 4727 WILLOW SPRINGS RD
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City | LA GRANGE
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State | IL
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Zip | 60525-6140
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Country | US
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Telephone | 708-352-3352
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Fax |
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Provider Business Mailing Address
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Address Line | 4727 WILLOW SPRINGS RD
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City | LA GRANGE
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State | IL
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Zip | 60525-6140
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Country | US
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Telephone | 708-352-3352
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GORDON K. FIMREITE
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Credential | D.C.
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Telephone | 708-352-3352
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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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