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General NPI Number Information
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NPI Number | 1639834294
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Entity Type | Organization
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Legal Business Name | BOUNCE BACK CHIROPRACTIC, INC.
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Dates
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Enumeration Date | 11/08/2021
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Last Update Date | 11/08/2021
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Provider Practice Location Address
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Address Line | 15620 CENTENNIAL CT
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City | ORLAND PARK
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State | IL
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Zip | 60462-4571
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Country | US
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Telephone | 708-843-2013
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Fax |
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Provider Business Mailing Address
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Address Line | 15620 CENTENNIAL CT
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City | ORLAND PARK
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State | IL
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Zip | 60462-4571
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Country | US
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Telephone | 708-843-2013
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SHEHAB K. AWADALLAH
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Credential | DC
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Telephone | 708-843-2013
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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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