Organization
ELGIN PHYSICAL HEALTH CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GREGORY GEORGE GIBBONS D.C. (PRESIDENT)
(847) 697-2211
Entity
Organization
Contact information
Practice address
1510 LARKIN AVE, ELGIN, IL 60123-5190
(847) 697-2211
(847) 697-2215
Mailing address
1510 LARKIN AVE, ELGIN, IL 60123-5190
(847) 697-2211
(847) 697-2215
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
—
IL
208100000X
Physical Medicine & Rehabilitation Physician
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0004515239
BC BS PROVIDER NUMBER
IL
Enumeration date
05/21/2007
Last updated
11/26/2007
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