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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