Organization
ORTHOPEDIC & SPORTS MEDICINE CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GREGG CHADWICK (CHIEF OPERATING OFFICER)
(309) 454-1616
Entity
Organization
Contact information
Practice address
2200 FORT JESSE RD STE 250, NORMAL, IL 61761-6290
(309) 454-1616
Mailing address
2200 FORT JESSE RD STE 250, NORMAL, IL 61761-6290
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
042-616684
IL
Other
Enumeration date
09/29/2006
Last updated
11/19/2008
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