Organization
AMBULATORY SURGICAL CARE FACILITY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DERRICK D WALLERY D.C. (CEO / PRESIDENT)
(773) 283-3131
Entity
Organization
Contact information
Practice address
1281 N FARNSWORTH AVE, AURORA, IL 60505-2445
(773) 283-3131
Mailing address
4176 W MONTROSE AVE, CHICAGO, IL 60641-2161
(773) 283-3131
(773) 283-0793
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
Other
Enumeration date
10/29/2010
Last updated
10/29/2010
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