Provider Demographics
NPI:1790122588
Name:VERDANT HEALTH SC
Entity Type:Organization
Organization Name:VERDANT HEALTH SC
Other - Org Name:ELM CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:GAZDACKA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:630-530-4744
Mailing Address - Street 1:475 S SPRING RD
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-3857
Mailing Address - Country:US
Mailing Address - Phone:630-530-4744
Mailing Address - Fax:
Practice Address - Street 1:475 S SPRING RD
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-3857
Practice Address - Country:US
Practice Address - Phone:630-530-4744
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-03
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038012446111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty