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Organization

NEUROLAB NEURODIAGNOSTIC SERVICES, SC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
GREGORY D THURSTON DC, DIBCN (PRESIDENT/OWNER)
(847) 477-7678
Entity
Organization

Contact information

Practice address
1614 N HARLEM AVE, ELMWOOD PARK, IL 60707-4302
(847) 477-4678
(847) 573-1944
Mailing address
PO BOX 178, LIBERTYVILLE, IL 60048-0178
(847) 477-7678
(847) 573-1944

Taxonomy

Speciality
Code
Description
License number
State
111NN0400X
Neurology Chiropractor
Primary
038-005346
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
4932633
BC/BS OF IL
IL
Enumeration date
01/31/2007
Last updated
04/30/2015
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