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General NPI Number Information
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NPI Number | 1871028563
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Entity Type | Organization
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Legal Business Name | DAVID LOW BACK CENTER DC
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Dates
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Enumeration Date | 05/01/2017
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Last Update Date | 05/01/2017
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Provider Practice Location Address
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Address Line | 1019 W GALENA AVE
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City | FREEPORT
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State | IL
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Zip | 61032-3819
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Country | US
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Telephone | 815-232-2225
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Fax | 815-233-2571
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Provider Business Mailing Address
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Address Line | 1019 W GALENA AVE
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City | FREEPORT
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State | IL
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Zip | 61032-3819
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Country | US
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Telephone | 815-232-2225
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Fax | 815-233-2571
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Authorized Official
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Title or Position | PATIENT ACCOUNTS MANAGER
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Name | NICHOLE JONES
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Credential |
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Telephone | 815-232-2225
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 227019370
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License Number State | IL
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