Organization
CRYSTAL LAKE FAMILY TREATMENT CENTER LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN S BALOCKI DO (PRESIDENT)
(815) 455-0310
Entity
Organization
Contact information
Practice address
185 HERITAGE DRIVE, SUITE 3, CRYSTAL LAKE, IL 60014
(815) 455-0310
(815) 455-1210
Mailing address
185 HERITAGE DRIVE, SUITE 3, CRYSTAL LAKE, IL 60014
(815) 455-0310
(815) 455-1210
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036073896
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036073896
—
IL
Enumeration date
04/03/2006
Last updated
11/12/2010
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