Healthcare Provider Details

I. General information

NPI: 1942547229
Provider Name (Legal Business Name): SYCAMORE INTEGRATED HEALTH, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2013
Last Update Date: 02/24/2025
Certification Date: 02/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 W PRAIRIE DR STE J
SYCAMORE IL
60178-3123
US

IV. Provider business mailing address

920 W PRAIRIE DR STE J
SYCAMORE IL
60178-3123
US

V. Phone/Fax

Practice location:
  • Phone: 815-895-3354
  • Fax: 815-895-3345
Mailing address:
  • Phone: 815-895-3354
  • Fax: 815-895-3345

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JUDI GALICK
Title or Position: BILLING MANAGER
Credential:
Phone: 815-895-3354