Healthcare Provider Details

I. General information

NPI: 1366585291
Provider Name (Legal Business Name): MCHENRY MEDICAL CENTER SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 12/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 S IL ROUTE 31
MCHENRY IL
60050-4018
US

IV. Provider business mailing address

202 S IL ROUTE 31
MCHENRY IL
60050-4018
US

V. Phone/Fax

Practice location:
  • Phone: 815-344-1192
  • Fax: 815-344-8070
Mailing address:
  • Phone: 815-344-1192
  • Fax: 815-344-8070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038-005325
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. TIMOTHY JAMES HARTLETT
Title or Position: OWNER
Credential: D.C.
Phone: 815-344-1192