Provider Demographics
NPI:1053521385
Name:COMPLETE REHABILITATION, LTD
Entity type:Organization
Organization Name:COMPLETE REHABILITATION, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICAHAEL
Authorized Official - Middle Name:REX
Authorized Official - Last Name:PINCKNEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:708-354-9599
Mailing Address - Street 1:507 S LA GRANGE RD
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:IL
Mailing Address - Zip Code:60525-6740
Mailing Address - Country:US
Mailing Address - Phone:708-354-9599
Mailing Address - Fax:708-354-9799
Practice Address - Street 1:507 S LA GRANGE RD
Practice Address - Street 2:
Practice Address - City:LA GRANGE
Practice Address - State:IL
Practice Address - Zip Code:60525-6740
Practice Address - Country:US
Practice Address - Phone:708-354-9599
Practice Address - Fax:708-354-9799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2008-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL042.618434111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedicGroup - Multi-Specialty