# QUIRAM SPINAL & SPORTS REHABILITATION LTD

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1780760413
- **Authorized official:** DR. LESLIE R QUIRAM D.C. (OWNER/OPERATOR)
- **Authorized official phone:** (309) 662-6462

## Contact information

- **Practice address:** 21108 N 25 EAST ROAD, DANVERS, IL 61732-4497
- **Practice address phone:** (309) 662-6462
- **Practice address fax:** (309) 965-2384
- **Mailing address:** 21108 N 25 EAST ROAD, DANVERS, IL 61732-4497
- **Mailing address phone:** (309) 662-6462
- **Mailing address fax:** (309) 965-2384

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 111NR0400X | Rehabilitation Chiropractor | 042-617717 | IL | Yes |

## Other

- **Enumeration date:** 10/27/2006
- **Last updated:** 08/05/2009