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General NPI Number Information
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NPI Number | 1740714450
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Entity Type | Organization
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Legal Business Name | ELITE RECOVERY CHIROPRACTIC INC
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Dates
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Enumeration Date | 04/19/2017
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Last Update Date | 06/07/2021
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Provider Practice Location Address
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Address Line | 519 W 87TH ST
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City | NAPERVILLE
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State | IL
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Zip | 60565-3128
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Country | US
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Telephone | 331-215-4919
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Fax | 331-215-4917
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Provider Business Mailing Address
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Address Line | 519 W 87TH ST
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City | NAPERVILLE
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State | IL
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Zip | 60565-3128
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Country | US
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Telephone | 331-215-4919
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Fax | 331-215-4917
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Authorized Official
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Title or Position | OWNER & CHIROPRACTOR
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Name | BRADY DREW MCDANIEL
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Credential | DC
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Telephone | 331-215-4919
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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 | 038011876
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License Number State | IL
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