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General NPI Number Information
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NPI Number | 1649306267
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Entity Type | Organization
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Legal Business Name | TRI CITY BALANCE CENTER S.C.
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Dates
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Enumeration Date | 02/26/2007
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Last Update Date | 04/20/2008
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Provider Practice Location Address
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Address Line | 302 RANDALL RD # 104-A
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City | GENEVA
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State | IL
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Zip | 60134-4209
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Country | US
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Telephone | 630-845-3177
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Fax | 630-377-4023
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Provider Business Mailing Address
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Address Line | 302 RANDALL RD # 104-A
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City | GENEVA
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State | IL
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Zip | 60134-4209
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Country | US
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Telephone | 630-845-3177
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Fax | 630-377-4023
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | MR. RONALD B BUKOWY
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Credential | MD
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Telephone | 630-377-4020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251N0400X
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Taxonomy Name | Neurology Physical Therapist
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License Number |
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License Number State |
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