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Organization

QUIRAM SPINAL & SPORTS REHABILITATION LTD

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. LESLIE R QUIRAM D.C. (OWNER/OPERATOR)
(309) 662-6462
Entity
Organization

Contact information

Practice address
21108 N 25 EAST ROAD, DANVERS, IL 61732-4497
(309) 662-6462
(309) 965-2384
Mailing address
21108 N 25 EAST ROAD, DANVERS, IL 61732-4497
(309) 662-6462
(309) 965-2384

Taxonomy

Speciality
Code
Description
License number
State
111NR0400X
Rehabilitation Chiropractor
Primary
042-617717
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
5732002
BLUE CROSS BLUE SHIELD
IL
Enumeration date
10/27/2006
Last updated
08/05/2009
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