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General NPI Number Information
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NPI Number | 1194497362
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Entity Type | Organization
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Legal Business Name | SUPERIOR HEALTH AND WELLNESS OF GURNEE, LTD
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Dates
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Enumeration Date | 10/05/2021
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Last Update Date | 10/05/2021
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Provider Practice Location Address
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Address Line | 10105 74TH ST STE 103
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City | KENOSHA
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State | WI
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Zip | 53142-7530
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Country | US
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Telephone | 847-858-5759
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Fax | 847-599-9901
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Provider Business Mailing Address
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Address Line | 495 N RIVERSIDE DR STE 102
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City | GURNEE
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State | IL
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Zip | 60031-5919
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Country | US
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Telephone | 847-858-5759
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Fax | 847-599-9901
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Authorized Official
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Title or Position | PRESIDENT
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Name | JODIE LYNN SCHULTZ
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Credential | DC
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Telephone | 847-599-9900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State |
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