Provider Demographics
NPI:1295943108
Name:NOURISHING MEDICINE,LLC
Entity type:Organization
Organization Name:NOURISHING MEDICINE,LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DELILAH
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:630-561-9696
Mailing Address - Street 1:4082 RIVER RDG
Mailing Address - Street 2:
Mailing Address - City:SANDWICH
Mailing Address - State:IL
Mailing Address - Zip Code:60548-6905
Mailing Address - Country:US
Mailing Address - Phone:630-479-9355
Mailing Address - Fax:630-566-1633
Practice Address - Street 1:101 EAST SECOND STREET
Practice Address - Street 2:UNIT 2
Practice Address - City:BIG ROCK
Practice Address - State:IL
Practice Address - Zip Code:60511-0173
Practice Address - Country:US
Practice Address - Phone:630-479-9355
Practice Address - Fax:630-566-1633
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2014-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038006687111NN1001X, 111NI0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NI0900XChiropractic ProvidersChiropractorInternistGroup - Single Specialty
No111NN1001XChiropractic ProvidersChiropractorNutritionGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILU19760Medicare UPIN