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General NPI Number Information
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NPI Number | 1184959686
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Entity Type | Organization
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Legal Business Name | MIDWEST HEALTH AND WELLNESS LLC
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Dates
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Enumeration Date | 10/16/2009
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Last Update Date | 10/16/2009
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Provider Practice Location Address
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Address Line | 978 S BARTLETT RD
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City | BARTLETT
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State | IL
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Zip | 60103-6500
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Country | US
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Telephone | 630-289-5290
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Fax | 630-289-5291
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Provider Business Mailing Address
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Address Line | 978 S BARTLETT RD
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City | BARTLETT
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State | IL
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Zip | 60103-6500
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Country | US
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Telephone | 630-289-5290
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Fax | 630-289-5291
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Authorized Official
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Title or Position | MANAGER
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Name | DR. HERMAN K LO
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Credential | D.C.
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Telephone | 630-289-5290
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 038009211
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License Number State | IL
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