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General NPI Number Information
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NPI Number | 1861870214
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Entity Type | Organization
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Legal Business Name | ELEVATED SPORT & PAIN THERAPY
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Dates
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Enumeration Date | 05/18/2015
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Last Update Date | 04/21/2016
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Provider Practice Location Address
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Address Line | 1635 N ASHLAND AVE APT 2
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City | CHICAGO
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State | IL
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Zip | 60622-1428
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Country | US
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Telephone | 630-272-5271
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Fax |
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Provider Business Mailing Address
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Address Line | 1635 N ASHLAND AVE APT 2
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City | CHICAGO
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State | IL
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Zip | 60622-1428
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Country | US
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Telephone | 630-272-5271
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. NICHOLAS EDWARD LORENZ
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Credential | D.N.
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Telephone | 630-272-5271
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 172P00000X
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Taxonomy Name | Naprapath
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License Number | 181000390
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License Number State | IL
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