1124148283 NPI number — MR. JILL SUZANNE WHEELER DC

Table of content: MR. JILL SUZANNE WHEELER DC (NPI 1124148283)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124148283 NPI number — MR. JILL SUZANNE WHEELER DC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WHEELER
Provider First Name:
JILL
Provider Middle Name:
SUZANNE
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
DC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1124148283
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/28/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 5988
Provider Second Line Business Mailing Address:
DEPT. 20-5030
Provider Business Mailing Address City Name:
CAROL STREAM
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60197-5988
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-468-1824
Provider Business Mailing Address Fax Number:
630-468-1834

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
281 W TOWNLINE RD
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
VERNON HILLS
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60061-4334
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
224-207-4060
Provider Business Practice Location Address Fax Number:
630-468-1834
Provider Enumeration Date:
03/30/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 4932806 . This is a "BCBS" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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