Healthcare Provider Details

I. General information

NPI: 1235476227
Provider Name (Legal Business Name): DUPAGE HEALTHCARE LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2013
Last Update Date: 04/05/2024
Certification Date: 04/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 S PARK BLVD SUITE 175
GLEN ELLYN IL
60137-6280
US

IV. Provider business mailing address

907 MAIN ST
BATAVIA IL
60510-4605
US

V. Phone/Fax

Practice location:
  • Phone: 630-858-9780
  • Fax: 773-337-9106
Mailing address:
  • Phone: 630-858-9780
  • Fax: 630-858-9793

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: SALLY PEPPING
Title or Position: OWNER
Credential: DC
Phone: 630-858-9780