1326207259 NPI number — INTEGRATIVE CHIROPRACTIC & WELLNESS, LLC

Table of content: DR. KATHLEEN LOUISE NIEGOCKI PH.D. (NPI 1649832445)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326207259 NPI number — INTEGRATIVE CHIROPRACTIC & WELLNESS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INTEGRATIVE CHIROPRACTIC & WELLNESS, LLC
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:
1326207259
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/05/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
106 CALENDAR CT
Provider Second Line Business Mailing Address:
SUITE 94
Provider Business Mailing Address City Name:
LA GRANGE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60525-2325
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
708-771-3471
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7756 MADISON ST
Provider Second Line Business Practice Location Address:
SUITE 8
Provider Business Practice Location Address City Name:
RIVER FOREST
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60305-2058
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-711-3471
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/05/2008

Additional Information

Authorized Official

Authorized Official Last Name:
MICHAELS
Authorized Official First Name:
PAUL
Authorized Official Middle Name:
DAVID
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
708-771-3471

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  038008307 , 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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