Provider Demographics
NPI:1104148733
Name:CONCORD NATURAL & NUTRITIONAL HEALTHCARE, PC
Entity type:Organization
Organization Name:CONCORD NATURAL & NUTRITIONAL HEALTHCARE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:M
Authorized Official - Last Name:HUSSONG
Authorized Official - Suffix:
Authorized Official - Credentials:DC, PT
Authorized Official - Phone:630-935-4530
Mailing Address - Street 1:800 ROOSEVELT RD
Mailing Address - Street 2:B-418
Mailing Address - City:GLEN ELLYN
Mailing Address - State:IL
Mailing Address - Zip Code:60137-5839
Mailing Address - Country:US
Mailing Address - Phone:630-474-9346
Mailing Address - Fax:630-474-9357
Practice Address - Street 1:800 ROOSEVELT RD
Practice Address - Street 2:B-418
Practice Address - City:GLEN ELLYN
Practice Address - State:IL
Practice Address - Zip Code:60137-5839
Practice Address - Country:US
Practice Address - Phone:630-474-9346
Practice Address - Fax:630-474-9357
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-24
Last Update Date:2012-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.003626225100000X
IL038.011509111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty