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General NPI Number Information
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NPI Number | 1215342829
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Entity Type | Organization
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Legal Business Name | ILLINOIS WELLNESS GROUP OF JOLIET, LTD
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Dates
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Enumeration Date | 06/23/2014
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Last Update Date | 10/02/2015
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Provider Practice Location Address
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Address Line | 815 N LARKIN AVE SUITE 105
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City | JOLIET
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State | IL
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Zip | 60435-3438
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Country | US
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Telephone | 815-714-2271
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Fax | 815-582-3262
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Provider Business Mailing Address
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Address Line | 815 N LARKIN AVE SUITE 105
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City | JOLIET
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State | IL
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Zip | 60435-3438
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Country | US
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Telephone | 815-714-2271
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Fax | 815-582-3262
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Authorized Official
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Title or Position | OWNER
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Name | DR. BRETT NOLAN NASH
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Credential | D.C.
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Telephone | 815-714-2271
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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