Provider Demographics
NPI:1285796680
Name:PHYSICIANS SPORTS & INJURY CENTER, INC
Entity type:Organization
Organization Name:PHYSICIANS SPORTS & INJURY CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DARRELL
Authorized Official - Middle Name:
Authorized Official - Last Name:WEHREND
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:630-323-2225
Mailing Address - Street 1:777 OAKMONT LN
Mailing Address - Street 2:SUITE 1000
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559-5511
Mailing Address - Country:US
Mailing Address - Phone:630-323-2225
Mailing Address - Fax:630-323-5230
Practice Address - Street 1:777 OAKMONT LN
Practice Address - Street 2:SUITE 1000
Practice Address - City:WESTMONT
Practice Address - State:IL
Practice Address - Zip Code:60559-5511
Practice Address - Country:US
Practice Address - Phone:630-323-2225
Practice Address - Fax:630-323-5230
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2010-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038008598111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL2230276OtherBCBS
IL2230276OtherBCBS