Provider Demographics
NPI:1891094801
Name:WELLNESS & NUTRITION CENTER, INC.
Entity Type:Organization
Organization Name:WELLNESS & NUTRITION CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JILL
Authorized Official - Middle Name:SHANNON
Authorized Official - Last Name:NOBLE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:847-426-2121
Mailing Address - Street 1:324 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CARPENTERSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60110-2844
Mailing Address - Country:US
Mailing Address - Phone:847-426-2121
Mailing Address - Fax:847-892-0449
Practice Address - Street 1:324 W MAIN ST
Practice Address - Street 2:
Practice Address - City:CARPENTERSVILLE
Practice Address - State:IL
Practice Address - Zip Code:60110-2844
Practice Address - Country:US
Practice Address - Phone:847-426-2121
Practice Address - Fax:847-892-0449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-17
Last Update Date:2011-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-007909111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty