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General NPI Number Information
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NPI Number | 1477803286
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Entity Type | Organization
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Legal Business Name | INTEGRATED HEALTH SOURCE S.C.
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Dates
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Enumeration Date | 09/19/2012
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Last Update Date | 08/27/2013
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Provider Practice Location Address
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Address Line | 2411 WEST JEFFERSON STREET
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City | JOLIET
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State | IL
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Zip | 60435-6448
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Country | US
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Telephone | 815-744-3505
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Fax |
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Provider Business Mailing Address
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Address Line | 2411 WEST JEFFERSON STREET
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City | JOLIET
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State | IL
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Zip | 60435-6448
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DAN CATARELLO
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Credential |
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Telephone | 847-254-1492
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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 | 038012017
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License Number State | IL
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