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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