Provider Demographics
NPI:1568804136
Name:WHITE OAK FAMILY WELLNESS, SC
Entity Type:Organization
Organization Name:WHITE OAK FAMILY WELLNESS, SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIC PHYSICIAN, PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:A
Authorized Official - Last Name:GAMBLE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:630-442-0057
Mailing Address - Street 1:511 ILLINOIS AVE
Mailing Address - Street 2:
Mailing Address - City:ST CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60174-2152
Mailing Address - Country:US
Mailing Address - Phone:630-442-0057
Mailing Address - Fax:630-791-0861
Practice Address - Street 1:511 ILLINOIS AVE
Practice Address - Street 2:
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60174-2152
Practice Address - Country:US
Practice Address - Phone:630-442-0057
Practice Address - Fax:630-791-0861
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-24
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038012389111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty