Provider Demographics
NPI:1689013393
Name:IDEAL HEALTH AND WELLNESS, SC
Entity Type:Organization
Organization Name:IDEAL HEALTH AND WELLNESS, SC
Other - Org Name:IDEAL HEALTH AND WELLNESS, SC, CORP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:
Authorized Official - Last Name:FREGA
Authorized Official - Suffix:
Authorized Official - Credentials:DC, ND
Authorized Official - Phone:563-359-4106
Mailing Address - Street 1:1850 E 53RD ST STE 2
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52807-2784
Mailing Address - Country:US
Mailing Address - Phone:563-359-4106
Mailing Address - Fax:563-359-4130
Practice Address - Street 1:1850 E 53RD ST STE 2
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-2784
Practice Address - Country:US
Practice Address - Phone:563-359-4106
Practice Address - Fax:563-359-4130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA083863111N00000X
111N00000X, 171100000X, 175F00000X, 207Q00000X, 363LF0000X
IL038012020111NI0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No111NI0900XChiropractic ProvidersChiropractorInternistGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No175F00000XOther Service ProvidersNaturopathGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty