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General NPI Number Information
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NPI Number | 1477758092
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Entity Type | Organization
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Legal Business Name | ANEW CHIROPRACTIC & PHYSICAL THERAPY S C
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Dates
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Enumeration Date | 06/15/2007
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Last Update Date | 03/02/2021
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Provider Practice Location Address
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Address Line | 115 REPUBLIC AVE
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City | JOLIET
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State | IL
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Zip | 60435-6515
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Country | US
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Telephone | 815-207-7463
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Fax |
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Provider Business Mailing Address
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Address Line | 115 REPUBLIC AVE
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City | JOLIET
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State | IL
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Zip | 60435-6515
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Country | US
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Telephone | 815-207-7463
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Fax |
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. LISA MARIE RUBIS
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Credential | D.C.
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Telephone | 815-207-7463
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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 | 038010952
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | 036078826
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License Number State | IL
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