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General NPI Number Information
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NPI Number | 1376810614
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Entity Type | Individual
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Provider Name | WHITNEY LEIGH FANDEL D.C.
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Gender | Female
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Dates
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Enumeration Date | 11/30/2011
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Last Update Date | 09/01/2016
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Provider Practice Location Address
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Address Line | 1440 RENAISSANCE DR STE 120
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City | PARK RIDGE
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State | IL
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Zip | 60068-1356
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Country | US
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Telephone | 847-403-1101
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Fax |
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Provider Business Mailing Address
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Address Line | 1440 RENAISSANCE DR STE 120 STE120
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City | PARK RIDGE
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State | IL
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Zip | 60068-1414
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Country | US
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Telephone | 847-403-1101
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 038012789
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 111NP0017X
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Taxonomy Name | Pediatric Chiropractor
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License Number | 038012789
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License Number State | IL
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