Healthcare Provider Details

I. General information

NPI: 1952172546
Provider Name (Legal Business Name): KWR MANAGEMENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2024
Last Update Date: 01/11/2024
Certification Date: 01/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2640 PATRIOT BLVD STE 220
GLENVIEW IL
60026-8075
US

IV. Provider business mailing address

2640 PATRIOT BLVD STE 220
GLENVIEW IL
60026-8075
US

V. Phone/Fax

Practice location:
  • Phone: 224-616-3002
  • Fax:
Mailing address:
  • Phone: 224-616-3002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. KAYLEE CONFER
Title or Position: DOCTOR
Credential: DC, ND
Phone: 586-531-6335