Provider Demographics
NPI:1689946725
Name:SUPERIORHEALTH & WELLNESS OF MCHENRY LTD
Entity Type:Organization
Organization Name:SUPERIORHEALTH & WELLNESS OF MCHENRY LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES.
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:HARTLETT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:815-344-1192
Mailing Address - Street 1:202 FRONT ST
Mailing Address - Street 2:SOUTH RTE 31
Mailing Address - City:MCHENRY
Mailing Address - State:IL
Mailing Address - Zip Code:60050
Mailing Address - Country:US
Mailing Address - Phone:815-344-1192
Mailing Address - Fax:815-344-8070
Practice Address - Street 1:202 FRONT ST
Practice Address - Street 2:SOUTH RTE 31
Practice Address - City:MCHENRY
Practice Address - State:IL
Practice Address - Zip Code:60050
Practice Address - Country:US
Practice Address - Phone:815-344-1192
Practice Address - Fax:815-344-8070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-06
Last Update Date:2012-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty