| NPI | 1720509631 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUPREET SHAH Clinic Director 847-730-9035 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA 32975) |
| 171100000X Acupuncturist (Licence: CA 16580) | |
| Enumeration Date | 2017-06-30 |
| Last Update Date | 2025-02-03 |