Healthcare Provider Details

I. General information

NPI: 1588013775
Provider Name (Legal Business Name): MATTHEW JACOB IMBER D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2016
Last Update Date: 10/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 HOBSON RD STE 220
NAPERVILLE IL
60540
US

IV. Provider business mailing address

1220 HOBSON RD STE 220
NAPERVILLE IL
60540-8138
US

V. Phone/Fax

Practice location:
  • Phone: 630-637-8887
  • Fax:
Mailing address:
  • Phone: 630-637-8887
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN0400X
TaxonomyNeurology Chiropractor
License Number038.012507
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number038.012507
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: