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General NPI Number Information
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NPI Number | 1578977328
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Entity Type | Organization
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Legal Business Name | OPTIONS MEDICAL LLC
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Dates
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Enumeration Date | 06/19/2014
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Last Update Date | 09/15/2014
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Provider Practice Location Address
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Address Line | 1147 S WABASH AVE SUITE 250
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City | CHICAGO
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State | IL
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Zip | 60605-2346
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Country | US
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Telephone | 312-360-1604
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Fax |
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Provider Business Mailing Address
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Address Line | 1147 S WABASH AVE SUITE 250
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City | CHICAGO
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State | IL
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Zip | 60605-2346
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Country | US
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Telephone | 312-360-1604
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | MATTHEW WALKER
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Credential |
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Telephone | 312-360-1604
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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 | 038012545
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 209011079
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 036127953
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License Number State | IL
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