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General NPI Number Information
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NPI Number | 1841661774
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Entity Type | Organization
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Legal Business Name | PETRAK FAMILY CHIROPRACTIC CENTER S.C
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Dates
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Enumeration Date | 10/19/2015
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Last Update Date | 10/19/2015
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Provider Practice Location Address
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Address Line | 3070 SOUTH WOLF RD
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City | WESTCHESTER
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State | IL
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Zip | 60154
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Country | US
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Telephone | 630-853-9971
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Fax |
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Provider Business Mailing Address
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Address Line | 3070 SOUTH WOLF RD
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City | WESTCHESTER
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State | IL
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Zip | 60154
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Country | US
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Telephone | 630-853-9971
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | STEPHEN PETRAK
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Credential | DC
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Telephone | 630-853-9971
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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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