Provider Demographics
NPI:1710436043
Name:MJMNMT, LLC
Entity Type:Organization
Organization Name:MJMNMT, LLC
Other - Org Name:LEMONT NATURAL HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:JACOB
Authorized Official - Last Name:IMBER
Authorized Official - Suffix:
Authorized Official - Credentials:DC, DACNB
Authorized Official - Phone:630-257-0550
Mailing Address - Street 1:1192 WALTER ST STE C
Mailing Address - Street 2:
Mailing Address - City:LEMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60439-2905
Mailing Address - Country:US
Mailing Address - Phone:630-257-0550
Mailing Address - Fax:
Practice Address - Street 1:1192 WALTER ST STE C
Practice Address - Street 2:
Practice Address - City:LEMONT
Practice Address - State:IL
Practice Address - Zip Code:60439-2905
Practice Address - Country:US
Practice Address - Phone:630-257-0550
Practice Address - Fax:630-257-0555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-28
Last Update Date:2016-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.012507111NN0400X
IL038.005323111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN0400XChiropractic ProvidersChiropractorNeurologyGroup - Multi-Specialty
No111NN1001XChiropractic ProvidersChiropractorNutritionGroup - Multi-Specialty