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General NPI Number Information
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NPI Number | 1861883647
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Entity Type | Organization
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Legal Business Name | OAK LAWN PAIN AND WELLNESS INC
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Dates
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Enumeration Date | 02/14/2015
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Last Update Date | 02/14/2015
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Provider Practice Location Address
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Address Line | 10250 CENTRAL AVE
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City | OAK LAWN
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State | IL
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Zip | 60453-4602
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Country | US
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Telephone | 708-423-5950
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Fax | 708-423-1909
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Provider Business Mailing Address
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Address Line | 10250 CENTRAL AVE
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City | OAK LAWN
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State | IL
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Zip | 60453-4602
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Country | US
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Telephone | 708-423-5950
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Fax | 708-423-1909
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. NATHAN TODD ROUF
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Credential | D.C.
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Telephone | 716-435-0462
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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 | 038011589
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License Number State | IL
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