Healthcare Provider Details

I. General information

NPI: 1093065641
Provider Name (Legal Business Name): DESIREE LYNETTE NORBERG D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2012
Last Update Date: 09/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 WELLS AVE LOT D
CASEYVILLE IL
62232-2088
US

IV. Provider business mailing address

901 WELLS AVE LOT D
CASEYVILLE IL
62232-2088
US

V. Phone/Fax

Practice location:
  • Phone: 618-616-5273
  • Fax:
Mailing address:
  • Phone: 618-616-5273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2012002897
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: