Provider Demographics
NPI:1558475103
Name:PHYSICIANS FOR NATURAL HEALTH AND WELLNESS, S.C.
Entity Type:Organization
Organization Name:PHYSICIANS FOR NATURAL HEALTH AND WELLNESS, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:HOGLIND
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:708-485-3260
Mailing Address - Street 1:9146 BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60513-1304
Mailing Address - Country:US
Mailing Address - Phone:708-485-3260
Mailing Address - Fax:
Practice Address - Street 1:9146 BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:IL
Practice Address - Zip Code:60513-1304
Practice Address - Country:US
Practice Address - Phone:708-485-3260
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL208316Medicare ID - Type Unspecified