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General NPI Number Information
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NPI Number | 1417067596
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Entity Type | Organization
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Legal Business Name | INNERPEACE NATURAL HEALTHCARE
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Dates
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Enumeration Date | 08/30/2006
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Last Update Date | 09/19/2012
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Provider Practice Location Address
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Address Line | 1002 INFANTRY DRIVE #E
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City | JOLIET
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State | IL
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Zip | 60435-3010
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Country | US
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Telephone | 815-773-2373
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Fax | 815-773-2374
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Provider Business Mailing Address
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Address Line | 1002 INFANTRY DRIVE #E
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City | JOLIET
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State | IL
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Zip | 60435-3010
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Country | US
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Telephone | 815-773-2373
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Fax | 815-773-2374
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Authorized Official
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Title or Position | PRESIDENT
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Name | CHERYL LYNN SHERIDAN
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Credential |
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Telephone | 815-773-2373
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 0170213387
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License Number State | IL
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