Provider Demographics
NPI:1679290845
Name:PIVOTAL HEALTH AND WELLNESS LLC
Entity Type:Organization
Organization Name:PIVOTAL HEALTH AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:BROD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:708-380-0090
Mailing Address - Street 1:684 W BOUGHTON RD STE 106
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-1781
Mailing Address - Country:US
Mailing Address - Phone:708-380-0090
Mailing Address - Fax:
Practice Address - Street 1:684 W BOUGHTON RD STE 106
Practice Address - Street 2:
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60440-1781
Practice Address - Country:US
Practice Address - Phone:708-380-0090
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-27
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty