1205003522 NPI number — BACK TO HEALTH CHIROPRACTIC WELLNESS CENTER

Table of content: DR. DANIELLE MARIE LION DNP, APN, CRNA (NPI 1689294399)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205003522 NPI number — BACK TO HEALTH CHIROPRACTIC WELLNESS CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BACK TO HEALTH CHIROPRACTIC WELLNESS CENTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1205003522
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/15/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1605 COUNTRY LAKES DR
Provider Second Line Business Mailing Address:
#204
Provider Business Mailing Address City Name:
NAPERVILLE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60563-9038
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-962-8277
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1605 COUNTRY LAKES DR
Provider Second Line Business Practice Location Address:
#204
Provider Business Practice Location Address City Name:
NAPERVILLE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60563-9038
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-962-8277
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/15/2008

Additional Information

Authorized Official

Authorized Official Last Name:
BURLISON
Authorized Official First Name:
STEVEN
Authorized Official Middle Name:
CHARLES
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
630-962-8277

Provider Taxonomy Codes

  • Taxonomy code: 305R00000X , with the licence number:  038011023 , 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)





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