Provider Demographics
NPI:1326340647
Name:RESTOR HEALING CENTRE INC
Entity Type:Organization
Organization Name:RESTOR HEALING CENTRE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTINA
Authorized Official - Middle Name:L
Authorized Official - Last Name:SARGENT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:630-682-5090
Mailing Address - Street 1:416 E ROOSEVELT RD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-5589
Mailing Address - Country:US
Mailing Address - Phone:630-682-5090
Mailing Address - Fax:630-260-1230
Practice Address - Street 1:416 E ROOSEVELT RD
Practice Address - Street 2:SUITE 107
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-5589
Practice Address - Country:US
Practice Address - Phone:630-682-5090
Practice Address - Fax:630-260-1230
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-18
Last Update Date:2010-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038007040111NI0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NI0900XChiropractic ProvidersChiropractorInternistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILSPACE HOLDER OTHER IOtherSPACE HOLDER OTHER ID