Provider Demographics
NPI:1619333580
Name:MIDWEST CENTER FOR HEALTH & WELLNESS
Entity Type:Organization
Organization Name:MIDWEST CENTER FOR HEALTH & WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:A
Authorized Official - Last Name:LAMBATOS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:951-675-6032
Mailing Address - Street 1:75 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:STREAMWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60107-1370
Mailing Address - Country:US
Mailing Address - Phone:951-675-6032
Mailing Address - Fax:
Practice Address - Street 1:110 E SCHILLER ST
Practice Address - Street 2:309
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-2858
Practice Address - Country:US
Practice Address - Phone:951-675-6032
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-07
Last Update Date:2016-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038012920111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty