1336296359 NPI number — HEALTH CARE ENTERPRISE

Table of content: (NPI 1336296359)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336296359 NPI number — HEALTH CARE ENTERPRISE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEALTH CARE ENTERPRISE
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:
6
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:
1336296359
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
707 W JEFFERSON STREET
Provider Second Line Business Mailing Address:
SUITE F
Provider Business Mailing Address City Name:
SHOREWOOD
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60404
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
815-725-8200
Provider Business Mailing Address Fax Number:
815-730-8576

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
707 W JEFFERSON STREET
Provider Second Line Business Practice Location Address:
SUITE F
Provider Business Practice Location Address City Name:
SHOREWOOD
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60404
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
815-725-8200
Provider Business Practice Location Address Fax Number:
815-730-8576
Provider Enumeration Date:
01/04/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DUARTE
Authorized Official First Name:
MANUEL
Authorized Official Middle Name:
A
Authorized Official Title or Position:
DIRECTOR - CHIROPRACTOR
Authorized Official Telephone Number:
815-725-8200

Provider Taxonomy Codes

  • Taxonomy code: 111NS0005X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 111NX0800X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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

  • Identifier: 9932246 . This is a "BCBS" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com