Provider Demographics
NPI:1194172148
Name:PROGRESSIVE WELLNESS AND REHABILITATION SC
Entity type:Organization
Organization Name:PROGRESSIVE WELLNESS AND REHABILITATION SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:BUCHAR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:630-820-1330
Mailing Address - Street 1:PO BOX 9042
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60567-0042
Mailing Address - Country:US
Mailing Address - Phone:630-820-1330
Mailing Address - Fax:630-820-1554
Practice Address - Street 1:3015 E NEW YORK ST STE A12
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60504-5163
Practice Address - Country:US
Practice Address - Phone:630-820-1330
Practice Address - Fax:630-820-1554
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-19
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038011851111N00000X
IL038011555207R00000X, 2081P2900X
IL085002931363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty