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General NPI Number Information
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NPI Number | 1477615185
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Entity Type | Organization
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Legal Business Name | PLATINUM CHIROPRACTIC P.C.
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Dates
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Enumeration Date | 12/16/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4615 W 103RD ST
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City | OAK LAWN
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State | IL
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Zip | 60453-4718
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Country | US
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Telephone | 708-601-7679
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Fax |
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Provider Business Mailing Address
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Address Line | 7003 W 114TH PL
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City | WORTH
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State | IL
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Zip | 60482-2042
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Country | US
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Telephone | 708-448-3624
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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. RORY J. MARRELLO
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Credential | D.C.
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Telephone | 708-448-3624
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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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