Provider Demographics
NPI:1063758530
Name:YOUR PERSONAL BEST
Entity type:Organization
Organization Name:YOUR PERSONAL BEST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-280-3784
Mailing Address - Street 1:18623 81ST AVE
Mailing Address - Street 2:
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60487-6279
Mailing Address - Country:US
Mailing Address - Phone:708-633-1000
Mailing Address - Fax:708-633-1096
Practice Address - Street 1:18623 81ST AVE
Practice Address - Street 2:
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60487-6279
Practice Address - Country:US
Practice Address - Phone:708-633-1000
Practice Address - Fax:708-633-1096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-02
Last Update Date:2013-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty