Healthcare Provider Details

I. General information

NPI: 1992048540
Provider Name (Legal Business Name): HEALTH ON EARTH OF NAPERVILLE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2013
Last Update Date: 04/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 S MAIN ST SUITE 294
NAPERVILLE IL
60540-5372
US

IV. Provider business mailing address

PO BOX 9000
NAPERVILLE IL
60567-9000
US

V. Phone/Fax

Practice location:
  • Phone: 630-428-2000
  • Fax:
Mailing address:
  • Phone: 312-225-5425
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: FRANK VAUGHT
Title or Position: MANAGER
Credential: D.C.
Phone: 312-225-5425