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General NPI Number Information
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NPI Number | 1104148733
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Entity Type | Organization
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Legal Business Name | CONCORD NATURAL & NUTRITIONAL HEALTHCARE, PC
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Dates
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Enumeration Date | 02/24/2010
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Last Update Date | 03/09/2012
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Provider Practice Location Address
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Address Line | 800 ROOSEVELT RD B-418
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City | GLEN ELLYN
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State | IL
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Zip | 60137-5839
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Country | US
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Telephone | 630-474-9346
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Fax | 630-474-9357
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Provider Business Mailing Address
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Address Line | 800 ROOSEVELT RD B-418
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City | GLEN ELLYN
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State | IL
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Zip | 60137-5839
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Country | US
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Telephone | 630-474-9346
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Fax | 630-474-9357
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Authorized Official
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Title or Position | OWNER/CEO
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Name | MS. JANICE M. HUSSONG
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Credential | DC, P.T.
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Telephone | 630-935-4530
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 070.003626
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 038.011509
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License Number State | IL
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