Healthcare Provider Details

I. General information

NPI: 1689946725
Provider Name (Legal Business Name): SUPERIORHEALTH & WELLNESS OF MCHENRY LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2012
Last Update Date: 02/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 FRONT ST SOUTH RTE 31
MCHENRY IL
60050
US

IV. Provider business mailing address

202 FRONT ST SOUTH RTE 31
MCHENRY IL
60050
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 TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number StateNULL
# 4
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number StateNULL

VIII. Authorized Official

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