1891186383 NPI number — CENTER FOR CHRISTIAN LIFE ENRICHMENT

Table of content: JENNIFER MARIE HERBST PT, DPT, ATC (NPI 1922335124)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891186383 NPI number — CENTER FOR CHRISTIAN LIFE ENRICHMENT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTER FOR CHRISTIAN LIFE ENRICHMENT
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:
1891186383
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/24/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3100 DUNDEE RD STE 102
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTHBROOK
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60062-2462
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-272-3684
Provider Business Mailing Address Fax Number:
847-272-7934

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3100 DUNDEE RD STE 102
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTHBROOK
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60062-2462
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-272-3684
Provider Business Practice Location Address Fax Number:
847-272-7934
Provider Enumeration Date:
02/05/2015

Additional Information

Authorized Official

Authorized Official Last Name:
NICOLOFF
Authorized Official First Name:
STEVE
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
847-272-3684

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  180.009135 , 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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