Healthcare Provider Details

I. General information

NPI: 1780706937
Provider Name (Legal Business Name): NORTHERN ILLINOIS HEALTH SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2007
Last Update Date: 09/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1820 WINDSOR RD SUITE A
LOVES PARK IL
61111-4271
US

IV. Provider business mailing address

1820 WINDSOR RD SUITE A
LOVES PARK IL
61111-4271
US

V. Phone/Fax

Practice location:
  • Phone: 815-986-4411
  • Fax: 815-986-4414
Mailing address:
  • Phone: 815-986-4411
  • Fax: 815-986-4414

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: DR. CLARKE SHIH
Title or Position: PRESIDENT
Credential: DC
Phone: 815-986-4411