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General NPI Number Information
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NPI Number | 1750985214
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Entity Type | Organization
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Legal Business Name | ILLINOIS BACK AND JOINT PLLC
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Dates
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Enumeration Date | 11/25/2020
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Last Update Date | 03/12/2021
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Provider Practice Location Address
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Address Line | 11540 183RD PL UNIT A
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City | ORLAND PARK
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State | IL
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Zip | 60467-9496
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Country | US
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Telephone | 630-677-3742
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Fax |
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Provider Business Mailing Address
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Address Line | 11540 183RD PL UNIT A
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City | ORLAND PARK
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State | IL
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Zip | 60467-9496
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | STELLA ZAIMI
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Credential |
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Telephone | 630-677-3742
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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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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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