Provider Demographics
NPI:1982815866
Name:SHEN TOV WELLNESS CENTER, INC.
Entity Type:Organization
Organization Name:SHEN TOV WELLNESS CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:ELIZABETH NICOLI
Authorized Official - Last Name:THURSBY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:773-529-4100
Mailing Address - Street 1:945 W GEORGE ST
Mailing Address - Street 2:SUITE 206
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-5893
Mailing Address - Country:US
Mailing Address - Phone:773-529-4100
Mailing Address - Fax:773-529-4200
Practice Address - Street 1:945 W GEORGE ST
Practice Address - Street 2:SUITE 206
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-5893
Practice Address - Country:US
Practice Address - Phone:773-529-4100
Practice Address - Fax:773-529-4200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL38010796111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01636902OtherBCBS