Provider Demographics
NPI:1932472446
Name:STRUCTURE INTEGRATIVE HEALTHCARE
Entity Type:Organization
Organization Name:STRUCTURE INTEGRATIVE HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CORTNEY
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:WEIGAND
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:630-447-0123
Mailing Address - Street 1:229 W OGDEN AVE
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-3047
Mailing Address - Country:US
Mailing Address - Phone:630-447-0123
Mailing Address - Fax:
Practice Address - Street 1:229 W OGDEN AVE
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-3047
Practice Address - Country:US
Practice Address - Phone:630-447-0123
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-14
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038012105111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty