=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508284373
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HEALTH ESSENTIALS, S. C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/31/2014
-----------------------------------------------------
Last Update Date | 03/31/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2811 S FAIRFIELD AVE SUITE E
-----------------------------------------------------
City | LOMBARD
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60148-1359
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 331-333-5897
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2811 S FAIRFIELD AVE SUITE E
-----------------------------------------------------
City | LOMBARD
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60148-1359
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 331-333-5897
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. DONALD MERTES
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 630-440-3392
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 038-009169
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------