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General NPI Number Information
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NPI Number | 1326129636
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Entity Type | Organization
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Legal Business Name | NORTHSTAR CHIROPRACTIC NATURAL WELLNESS CENTER
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Dates
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Enumeration Date | 10/17/2006
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Last Update Date | 01/02/2013
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Provider Practice Location Address
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Address Line | 4513 LINCOLN AVE SUITE 212
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City | LISLE
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State | IL
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Zip | 60532-1289
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Country | US
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Telephone | 630-795-1889
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Fax | 630-281-2802
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Provider Business Mailing Address
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Address Line | 4513 LINCOLN AVE SUITE 212
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City | LISLE
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State | IL
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Zip | 60532-1289
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Country | US
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Telephone | 630-795-1889
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Fax | 630-281-2802
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. PAUL DAVID RIESELMAN
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Credential | DC
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Telephone | 630-795-1889
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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 | 060008903
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License Number State | IL
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