Provider Demographics
NPI:1225329295
Name:ERBS ORGANIC WELLNESS CENTER
Entity Type:Organization
Organization Name:ERBS ORGANIC WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:J
Authorized Official - Last Name:ERBS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:708-629-0708
Mailing Address - Street 1:6420 W 127TH ST
Mailing Address - Street 2:SUITE 106
Mailing Address - City:PALOS HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60463-2269
Mailing Address - Country:US
Mailing Address - Phone:708-629-0708
Mailing Address - Fax:
Practice Address - Street 1:7519 175TH ST
Practice Address - Street 2:UNIT 1E
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60477-6929
Practice Address - Country:US
Practice Address - Phone:708-466-1085
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-26
Last Update Date:2011-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.011637111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL038.011637OtherSTATE LICENSE