Provider Demographics
NPI:1538633441
Name:87TH STREET REHAB CLINIC LLC
Entity type:Organization
Organization Name:87TH STREET REHAB CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:MANISH
Authorized Official - Middle Name:
Authorized Official - Last Name:PANDYA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:630-965-2225
Mailing Address - Street 1:1111 E 87TH ST STE 900B
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60619-7063
Mailing Address - Country:US
Mailing Address - Phone:708-452-6842
Mailing Address - Fax:708-452-1444
Practice Address - Street 1:1111 E 87TH ST STE 900B
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60619-7063
Practice Address - Country:US
Practice Address - Phone:708-452-6842
Practice Address - Fax:708-452-1444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-14
Last Update Date:2019-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty