Provider Demographics
NPI:1720231871
Name:ESSENTIAL HEALTHCARE, LLC
Entity Type:Organization
Organization Name:ESSENTIAL HEALTHCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHADI
Authorized Official - Middle Name:HOJATI
Authorized Official - Last Name:MCMILLAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-788-1980
Mailing Address - Street 1:742 N MARKET ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:WATERLOO
Mailing Address - State:IL
Mailing Address - Zip Code:62298-1079
Mailing Address - Country:US
Mailing Address - Phone:618-939-9850
Mailing Address - Fax:618-939-9860
Practice Address - Street 1:742 N MARKET ST
Practice Address - Street 2:SUITE D
Practice Address - City:WATERLOO
Practice Address - State:IL
Practice Address - Zip Code:62298-1079
Practice Address - Country:US
Practice Address - Phone:618-939-9850
Practice Address - Fax:618-939-9860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-01
Last Update Date:2009-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038011126111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL216231Medicare PIN