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General NPI Number Information
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NPI Number | 1881010841
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Entity Type | Organization
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Legal Business Name | ATHLETIC OUTCOMES
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Dates
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Enumeration Date | 03/13/2014
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Last Update Date | 03/13/2014
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Provider Practice Location Address
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Address Line | 1101 W MONROE ST SUITE A- BASEMENT
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City | CHICAGO
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State | IL
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Zip | 60607-2513
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Country | US
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Telephone | 207-694-1986
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Fax |
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Provider Business Mailing Address
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Address Line | 3430 W SHAKESPEARE AVE
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City | CHICAGO
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State | IL
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Zip | 60647-3522
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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 | OWNER
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Name | DR. BRITTANEY MCGARY
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Credential |
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Telephone | 207-694-1986
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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 | 038011928
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License Number State | IL
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