Provider Demographics
NPI:1760744106
Name:ILLINOIS WELLNESS GROUP OF NAPERVILLE, S.C.
Entity Type:Organization
Organization Name:ILLINOIS WELLNESS GROUP OF NAPERVILLE, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:M
Authorized Official - Last Name:GLAUS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:480-227-7144
Mailing Address - Street 1:3416 S ROUTE 59
Mailing Address - Street 2:SUITE 108
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60564-8148
Mailing Address - Country:US
Mailing Address - Phone:630-416-1151
Mailing Address - Fax:630-416-1158
Practice Address - Street 1:3416 S ROUTE 59
Practice Address - Street 2:SUITE 108
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60564-8148
Practice Address - Country:US
Practice Address - Phone:630-416-1151
Practice Address - Fax:630-416-1158
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-12
Last Update Date:2013-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Multi-Specialty
No133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports MedicineGroup - Multi-Specialty
No2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports MedicineGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty