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General NPI Number Information
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NPI Number | 1770290629
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Entity Type | Organization
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Legal Business Name | CHAMPION CHIROPRACTIC AND SPORTS REHAB
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Dates
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Enumeration Date | 10/31/2022
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Last Update Date | 10/31/2022
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Provider Practice Location Address
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Address Line | 500 SKOKIE BLVD
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City | NORTHBROOK
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State | IL
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Zip | 60062-2856
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Country | US
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Telephone | 847-409-5491
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Fax |
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Provider Business Mailing Address
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Address Line | 1525 LAKE COOK RD APT 258
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City | DEERFIELD
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State | IL
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Zip | 60015-5298
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Country | US
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Telephone | 847-409-5491
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Fax |
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | DR. MYLES NAGEL
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Credential |
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Telephone | 847-409-5491
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NR0400X
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Taxonomy Name | Rehabilitation Chiropractor
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License Number |
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License Number State |
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