=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457473944
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BARTLETT CHIROPRACTIC DBA DOCTORS' CENTER FOR INTEGRATIVE WELLNESS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/04/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1045 BURLINGTON AVE #1
-----------------------------------------------------
City | LISLE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60532-1887
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-960-9355
-----------------------------------------------------
Fax | 630-960-9392
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1045 BURLINGTON AVE #1
-----------------------------------------------------
City | LISLE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60532-1887
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-960-9355
-----------------------------------------------------
Fax | 630-960-9392
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. BETH ANNE BARTLETT
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 630-960-9355
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111NI0900X
-----------------------------------------------------
Taxonomy Name | Internist Chiropractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------