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General NPI Number Information
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NPI Number | 1932474772
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Entity Type | Organization
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Legal Business Name | INTEGRATIVE PHYSICAL MEDICINE OF CHICAGO INC
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Dates
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Enumeration Date | 03/13/2012
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Last Update Date | 03/13/2012
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Provider Practice Location Address
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Address Line | 1315 W 22ND ST SUITE 110
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City | OAK BROOK
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State | IL
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Zip | 60523-2057
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Country | US
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Telephone | 312-462-4444
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Fax |
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Provider Business Mailing Address
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Address Line | 954 CRESCENT BLVD
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City | GLEN ELLYN
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State | IL
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Zip | 60137-4255
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Country | US
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Telephone | 312-462-4444
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Fax | 312-626-2070
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Authorized Official
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Title or Position | PRESIDENT
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Name | MARC OTT
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Credential | DC
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Telephone | 407-977-3842
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 036-086579
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License Number State | IL
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