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General NPI Number Information
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NPI Number | 1497084420
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Entity Type | Organization
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Legal Business Name | REVIVE CHIROPRACTIC & REHABILITATION CARE LTD.
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Dates
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Enumeration Date | 12/22/2009
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Last Update Date | 12/22/2009
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Provider Practice Location Address
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Address Line | 9711 SKOKIE BLVD STE. #F
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City | SKOKIE
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State | IL
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Zip | 60077-1384
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Country | US
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Telephone | 773-282-4300
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Fax | 773-282-4301
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Provider Business Mailing Address
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Address Line | 9711 SKOKIE BLVD STE. #F
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City | SKOKIE
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State | IL
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Zip | 60077-1384
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Country | US
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Telephone | 773-282-4300
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Fax | 773-282-4301
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Authorized Official
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Title or Position | OWNER
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Name | WITOLD T GOZDALSKI
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Credential | DC
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Telephone | 773-282-4300
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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 |
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