Healthcare Provider Details

I. General information

NPI: 1548363088
Provider Name (Legal Business Name): HERWIG CHIROPRACTIC LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2006
Last Update Date: 12/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

712 N BLOOMINGTON ST
STREATOR IL
61364-2087
US

IV. Provider business mailing address

712 N BLOOMINGTON ST
STREATOR IL
61364-2087
US

V. Phone/Fax

Practice location:
  • Phone: 815-672-6961
  • Fax: 815-672-6891
Mailing address:
  • Phone: 815-672-6961
  • Fax: 815-672-6891

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038007374
License Number StateIL

VIII. Authorized Official

Name: DR. WILLIAM CURTIS HERWIG
Title or Position: PRESIDENT
Credential: DC
Phone: 630-208-9332