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General NPI Number Information
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NPI Number | 1710079710
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Entity Type | Organization
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Legal Business Name | CHIRO-MED SPORTS CLINIC, INC.
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Dates
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Enumeration Date | 09/28/2006
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Last Update Date | 08/04/2012
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Provider Practice Location Address
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Address Line | 3100 DUNDEE ROAD SUITE 506
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City | NORTHBROOK
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State | IL
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Zip | 60062-2437
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Country | US
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Telephone | 847-562-0888
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Fax | 847-562-0842
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Provider Business Mailing Address
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Address Line | 3100 DUNDEE RD SUITE 506
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City | NORTHBROOK
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State | IL
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Zip | 60062-2437
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Country | US
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Telephone | 847-562-0888
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Fax | 847-562-0842
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. HAL STEIN
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Credential | D.C.
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Telephone | 847-562-0888
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NI0900X
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Taxonomy Name | Internist Chiropractor
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License Number | 038007974
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License Number State | IL
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