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General NPI Number Information
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NPI Number | 1861638991
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Entity Type | Organization
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Legal Business Name | ACCELERATED SPORTS PERFORMANCE CENTERS, INC.
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Dates
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Enumeration Date | 12/18/2008
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Last Update Date | 12/18/2008
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Provider Practice Location Address
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Address Line | 195 N HARBOR DR UNIT 2908
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City | CHICAGO
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State | IL
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Zip | 60601-7514
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Country | US
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Telephone | 312-402-0081
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Fax |
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Provider Business Mailing Address
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Address Line | 195 N HARBOR DR UNIT 2908
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City | CHICAGO
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State | IL
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Zip | 60601-7514
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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 | CEO/CHIROPRACTOR
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Name | DIVYA J SHARMA
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Credential | D.C.
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Telephone | 312-402-0081
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NS0005X
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Taxonomy Name | Sports Physician Chiropractor
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License Number | 038-009825
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License Number State | IL
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