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NPI Code Detail

MEDICARE: ENVISION HEALTH CLINIC

MEDICARE: ENVISION HEALTH CLINIC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1111N00000XChiropractor038011833IL
2111N00000XChiropractor038012962IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1038011833OTHERILILLINOIS DEPARTMENT OF FINANCIAL AND PROFESSIONAL REGULATION
2038012962OTHERILILLINOIS DEPARTMENT OF FINANCIAL AND PROFESSIONAL REGULATION

General Provider Information

NPI Number : 1184079782
Entity Type Code : Organization
Provider Name (Legal Business Name) : ENVISION HEALTH CLINIC
Provider Business Mailing Address
First Line : 840 S WAUKEGAN RD
Second Line : #201
City : LAKE FOREST
State : IL
Zip : 60045-2608
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 840 S WAUKEGAN RD
Second Line : #201
City : LAKE FOREST
State : IL
Zip : 60045-2608
Country : US
Telephone Number : 224-544-5033
Fax Number :
Authorized Official
Title or Position : OWNER
Name : KIMBERLY C FLETCHER
Credential : DC
Telephone Number : 224-544-5033
Provider Enumeration Date : 05/02/2016
Last Update Date : 05/02/2016

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Directions to “ENVISION HEALTH CLINIC ” Practice Location

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