Provider Demographics
NPI:1750556825
Name:ADVANCED NATURAL HEALTH
Entity type:Organization
Organization Name:ADVANCED NATURAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:D.C
Authorized Official - Prefix:DR
Authorized Official - First Name:SITIHIAMPHONE
Authorized Official - Middle Name:
Authorized Official - Last Name:PHETCHAMPHONE
Authorized Official - Suffix:
Authorized Official - Credentials:DC LAC
Authorized Official - Phone:630-833-3799
Mailing Address - Street 1:17W300 22ND ST
Mailing Address - Street 2:SUITE 460
Mailing Address - City:OAKBROOK TERRACE
Mailing Address - State:IL
Mailing Address - Zip Code:60181-4405
Mailing Address - Country:US
Mailing Address - Phone:630-833-3799
Mailing Address - Fax:630-833-3830
Practice Address - Street 1:17W300 22ND ST
Practice Address - Street 2:SUITE 460
Practice Address - City:OAKBROOK TERRACE
Practice Address - State:IL
Practice Address - Zip Code:60181-4405
Practice Address - Country:US
Practice Address - Phone:630-833-3799
Practice Address - Fax:630-833-3830
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-29
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038009954111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedicGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL2232336OtherBCBS-IL
IL207582Medicare PIN