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General NPI Number Information
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NPI Number | 1801516737
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Entity Type | Organization
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Legal Business Name | STRETCHCLUB NAPERVILLE S.C.
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Dates
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Enumeration Date | 08/31/2022
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Last Update Date | 10/21/2022
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Provider Practice Location Address
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Address Line | 47 E CHICAGO AVE STE 332B
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City | NAPERVILLE
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State | IL
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Zip | 60540-5360
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Country | US
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Telephone | 312-763-6542
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Fax | 630-566-5965
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Provider Business Mailing Address
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Address Line | 47 E CHICAGO AVE STE 332B
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City | NAPERVILLE
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State | IL
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Zip | 60540-5360
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Country | US
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Telephone | 630-777-5721
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Fax | 630-566-5965
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Authorized Official
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Title or Position | OWNER
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Name | MARK D GLYNN
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Credential | DC
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Telephone | 630-777-5721
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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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