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General NPI Number Information
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NPI Number | 1841493111
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Entity Type | Organization
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Legal Business Name | SYCAMORE SERVICE CORPORATION
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Dates
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Enumeration Date | 06/06/2007
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Last Update Date | 08/08/2008
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Provider Practice Location Address
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Address Line | 1680 MEDITERRANEAN DR UNIT 101
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City | SYCAMORE
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State | IL
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Zip | 60178-3142
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Country | US
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Telephone | 815-899-6061
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Fax |
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Provider Business Mailing Address
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Address Line | 1680 MEDITERRANEAN DR UNIT 101
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City | SYCAMORE
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State | IL
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Zip | 60178-3142
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Country | US
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Telephone | 815-899-6061
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Fax |
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Authorized Official
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Title or Position | CLINIC DIRECTOR
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Name | JUSTIN M. COOP
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Credential | D.C.
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Telephone | 815-899-6061
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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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