Healthcare Provider Details

I. General information

NPI: 1295943108
Provider Name (Legal Business Name): NOURISHING MEDICINE,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 03/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 EAST SECOND STREET UNIT 2
BIG ROCK IL
60511-0173
US

IV. Provider business mailing address

4082 RIVER RDG
SANDWICH IL
60548-6905
US

V. Phone/Fax

Practice location:
  • Phone: 630-479-9355
  • Fax: 630-566-1633
Mailing address:
  • Phone: 630-479-9355
  • Fax: 630-566-1633

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NI0900X
TaxonomyInternist Chiropractor
License Number038006687
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number038006687
License Number StateIL

VIII. Authorized Official

Name: DR. DELILAH ANDERSON
Title or Position: OWNER PHYSICIAN
Credential: DC
Phone: 630-561-9696