Healthcare Provider Details

I. General information

NPI: 1578658811
Provider Name (Legal Business Name): NORTH SHORE NAPRAPATHIC FITNESS & WELLNESS CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 11/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3330 DUNDEE RD SUITE S5
NORTHBROOK IL
60062-2318
US

IV. Provider business mailing address

3330 DUNDEE RD SUITE S5
NORTHBROOK IL
60062-2318
US

V. Phone/Fax

Practice location:
  • Phone: 847-272-3700
  • Fax:
Mailing address:
  • Phone: 847-272-3700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172P00000X
TaxonomyNaprapath
License Number181000302
License Number StateIL

VIII. Authorized Official

Name: DR. DARYL NEWMAN
Title or Position: LICENSED NAPRAPATH
Credential: D.N.
Phone: 847-272-3700