Provider Demographics
NPI:1699179010
Name:RESTORATION HEALTH & CHIROPRACTIC
Entity Type:Organization
Organization Name:RESTORATION HEALTH & CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:FAZIO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:901-335-6006
Mailing Address - Street 1:365 E. BAILEY RD.
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60565
Mailing Address - Country:US
Mailing Address - Phone:630-506-7758
Mailing Address - Fax:630-364-2133
Practice Address - Street 1:365 E. BAILEY RD.
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60565
Practice Address - Country:US
Practice Address - Phone:630-506-7758
Practice Address - Fax:630-364-2133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-14
Last Update Date:2015-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-011411111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty