Healthcare Provider Details

I. General information

NPI: 1285024844
Provider Name (Legal Business Name): DOWNERS GROVE TOTAL HEALTH SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2015
Last Update Date: 02/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 WOODCREEK DR SUITE 120
DOWNERS GROVE IL
60515-5401
US

IV. Provider business mailing address

3000 WOODCREEK DR SUITE 120
DOWNERS GROVE IL
60515-5401
US

V. Phone/Fax

Practice location:
  • Phone: 630-519-3239
  • Fax:
Mailing address:
  • Phone: 630-519-3239
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number StateIL

VIII. Authorized Official

Name: CHRIS DOERSAM
Title or Position: PRESIDENT
Credential: DC
Phone: 815-541-0414