Healthcare Provider Details

I. General information

NPI: 1003107350
Provider Name (Legal Business Name): LISA MARIE BORGEALT D.C., APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2011
Last Update Date: 05/19/2023
Certification Date: 05/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

640 S WASHINGTON ST
NAPERVILLE IL
60540-6603
US

IV. Provider business mailing address

PO BOX 713260
CHICAGO IL
60677-1950
US

V. Phone/Fax

Practice location:
  • Phone: 815-942-6323
  • Fax: 815-942-6363
Mailing address:
  • Phone: 630-469-9200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number0038008429
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209-025425
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: