Organization
ELM STREET MEDICAL CENTER LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KENNETH T. REISER D.C. (OWNER)
(815) 344-1025
Entity
Organization
Contact information
Practice address
4921 W ELM ST, SUITE A, MCHENRY, IL 60050-4020
(815) 344-1025
(815) 344-1208
Mailing address
4921 W ELM ST, SUITE A, MCHENRY, IL 60050-4020
(815) 344-1025
(815) 344-1208
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
038-005010
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
038005010
—
IL
01
—
05632034
BLUE CROSS PROVIDER NUMBE
IL
Enumeration date
04/10/2007
Last updated
08/21/2013
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