Provider Demographics
NPI:1417379785
Name:PREFERRED MEDICAL CENTER
Entity Type:Organization
Organization Name:PREFERRED MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:M
Authorized Official - Last Name:VANDERWEIT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:847-546-4220
Mailing Address - Street 1:314 W ROLLINS RD STE B
Mailing Address - Street 2:
Mailing Address - City:ROUND LAKE BEACH
Mailing Address - State:IL
Mailing Address - Zip Code:60073-1204
Mailing Address - Country:US
Mailing Address - Phone:847-546-4220
Mailing Address - Fax:847-546-4262
Practice Address - Street 1:314 W ROLLINS RD STE B
Practice Address - Street 2:
Practice Address - City:ROUND LAKE BEACH
Practice Address - State:IL
Practice Address - Zip Code:60073-1204
Practice Address - Country:US
Practice Address - Phone:847-546-4220
Practice Address - Fax:847-546-4262
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-06
Last Update Date:2014-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036101899207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty