Provider Demographics
NPI:1881845691
Name:HEALTHSOURCE OF PLAINFIELD LTD
Entity Type:Organization
Organization Name:HEALTHSOURCE OF PLAINFIELD LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:BREUER-HAREJ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:319-850-1512
Mailing Address - Street 1:24020 W RIVERWALK CT
Mailing Address - Street 2:SUITE 118
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60544-7103
Mailing Address - Country:US
Mailing Address - Phone:815-782-7097
Mailing Address - Fax:815-782-7167
Practice Address - Street 1:24020 W RIVERWALK CT
Practice Address - Street 2:SUITE 118
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60544-7103
Practice Address - Country:US
Practice Address - Phone:815-782-7097
Practice Address - Fax:815-782-7167
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-10
Last Update Date:2014-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-011006111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty