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Organization
CRESTWOOD ASSOCIATED MEDICAL CENTER LTD
Active
Organization
CRESTWOOD ASSOCIATED MEDICAL CENTER LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN WILLIAM REVELLO D.C. (PRESIDENT)
(708) 385-4416
Entity
Organization
Contact information
Practice address
13705 CICERO AVE, CRESTWOOD, IL 60418-1824
(708) 385-4416
(708) 388-8825
Mailing address
13705 S. CICERO AVE., CRESTWOOD, IL 60445
(708) 385-4416
(708) 388-8825
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
038010310
IL
207Q00000X
Family Medicine Physician
Primary
036.103914
IL
207X00000X
Orthopaedic Surgery Physician
036039801
IL
261QP2000X
Physical Therapy Clinic/Center
070.005243
IL
Other
Enumeration date
08/10/2017
Last updated
07/21/2022
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