Healthcare Provider Details

I. General information

NPI: 1750960167
Provider Name (Legal Business Name): ORCHARD NATURAL MEDICINE, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2021
Last Update Date: 04/09/2021
Certification Date: 04/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2418 W INDIAN TRL STE A
AURORA IL
60506-1590
US

IV. Provider business mailing address

217 LONG AVE
NORTH AURORA IL
60542-1228
US

V. Phone/Fax

Practice location:
  • Phone: 630-962-6073
  • Fax:
Mailing address:
  • Phone: 630-618-8559
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NP0017X
TaxonomyPediatric Chiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code111NI0900X
TaxonomyInternist Chiropractor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. JODI E PERRIN
Title or Position: OWNER/PHYSICIAN
Credential: DC ND
Phone: 630-962-6073