Provider Demographics
NPI:1235144957
Name:WOODWARD MEDICAL CENTER, LTD
Entity Type:Organization
Organization Name:WOODWARD MEDICAL CENTER, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:DE PAOLO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:630-985-4700
Mailing Address - Street 1:2007 75TH ST
Mailing Address - Street 2:
Mailing Address - City:WOODRIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60517-2308
Mailing Address - Country:US
Mailing Address - Phone:630-985-4700
Mailing Address - Fax:630-985-4523
Practice Address - Street 1:2007 75TH ST
Practice Address - Street 2:
Practice Address - City:WOODRIDGE
Practice Address - State:IL
Practice Address - Zip Code:60517-2308
Practice Address - Country:US
Practice Address - Phone:630-985-4700
Practice Address - Fax:630-985-4523
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2012-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL042007972111NI0900X, 133NN1002X, 171100000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NI0900XChiropractic ProvidersChiropractorInternistGroup - Multi-Specialty
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, EducationGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL6141070001Medicare NSC