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General NPI Number Information
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NPI Number | 1932782323
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Entity Type | Individual
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Provider Name | REMINGTON RODELA DC
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Gender | Male
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Dates
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Enumeration Date | 05/03/2021
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Last Update Date | 05/03/2021
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Provider Practice Location Address
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Address Line | 2009 WARRENVILLE RD STE C
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City | LISLE
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State | IL
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Zip | 60532-2373
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Country | US
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Telephone | 630-515-0001
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Fax |
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Provider Business Mailing Address
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Address Line | 522 CHARLESTOWN DR
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City | BOLINGBROOK
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State | IL
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Zip | 60440-1249
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Country | US
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Telephone | 630-740-3079
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 038.013707
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License Number State | IL
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