Provider Demographics
NPI:1932528940
Name:OAK PARK SPORTS MEDICINE
Entity type:Organization
Organization Name:OAK PARK SPORTS MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEAD PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ARIAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:LECUONA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:708-406-9459
Mailing Address - Street 1:1144 LAKE ST
Mailing Address - Street 2:203
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60301-6705
Mailing Address - Country:US
Mailing Address - Phone:708-406-9459
Mailing Address - Fax:
Practice Address - Street 1:1144 LAKE ST
Practice Address - Street 2:203
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60301-6705
Practice Address - Country:US
Practice Address - Phone:708-406-9459
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-08
Last Update Date:2014-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.012565111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedicGroup - Single Specialty