| NPI | 1164475976 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WENDY NEWMAN Comptroller 815-227-9900 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036-090393) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038-009573) |
| Enumeration Date | 2006-05-19 |
| Last Update Date | 2020-08-22 |