Provider Demographics
NPI:1326129636
Name:NORTHSTAR CHIROPRACTIC NATURAL WELLNESS CENTER
Entity Type:Organization
Organization Name:NORTHSTAR CHIROPRACTIC NATURAL WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:RIESELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:630-795-1889
Mailing Address - Street 1:4513 LINCOLN AVE
Mailing Address - Street 2:SUITE 212
Mailing Address - City:LISLE
Mailing Address - State:IL
Mailing Address - Zip Code:60532-1289
Mailing Address - Country:US
Mailing Address - Phone:630-795-1889
Mailing Address - Fax:630-281-2802
Practice Address - Street 1:4513 LINCOLN AVE
Practice Address - Street 2:SUITE 212
Practice Address - City:LISLE
Practice Address - State:IL
Practice Address - Zip Code:60532-1289
Practice Address - Country:US
Practice Address - Phone:630-795-1889
Practice Address - Fax:630-281-2802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2013-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL060008903261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILY32959Medicare UPIN
IL211531Medicare PIN