Provider Demographics
NPI:1801294194
Name:OAK PARK PHYSIOTHERAPY
Entity type:Organization
Organization Name:OAK PARK PHYSIOTHERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:M
Authorized Official - Last Name:HAGEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:708-848-7766
Mailing Address - Street 1:6435 NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60302-1013
Mailing Address - Country:US
Mailing Address - Phone:708-848-7766
Mailing Address - Fax:773-337-9106
Practice Address - Street 1:6435 NORTH AVE
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60302-1013
Practice Address - Country:US
Practice Address - Phone:708-848-7766
Practice Address - Fax:773-337-9106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-18
Last Update Date:2014-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038007932111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty