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General NPI Number Information
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NPI Number | 1083196596
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Entity Type | Organization
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Legal Business Name | ESSENTIAL WELLNESS & PAIN CENTER, LTD
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Dates
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Enumeration Date | 08/30/2018
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Last Update Date | 08/30/2018
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Provider Practice Location Address
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Address Line | 7231 W 103RD ST
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City | PALOS HILLS
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State | IL
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Zip | 60465-2064
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Country | US
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Telephone | 708-233-0022
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Fax | 708-233-2322
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Provider Business Mailing Address
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Address Line | 7231 W 103RD ST
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City | PALOS HILLS
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State | IL
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Zip | 60465-2064
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Country | US
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Telephone | 708-233-0022
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Fax | 708-233-2322
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Authorized Official
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Title or Position | OWNER
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Name | DR. RORY MCKENNA
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Credential |
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Telephone | 312-669-4536
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 209.017714
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License Number State | IL
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