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General NPI Number Information
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NPI Number | 1629322300
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Entity Type | Organization
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Legal Business Name | NATURAL HEALING OF WAUCONDA
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Dates
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Enumeration Date | 11/02/2012
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Last Update Date | 11/02/2012
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Provider Practice Location Address
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Address Line | 115 E LIBERTY ST
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City | WAUCONDA
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State | IL
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Zip | 60084-1929
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Country | US
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Telephone | 847-477-6465
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Fax |
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Provider Business Mailing Address
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Address Line | 115 E LIBERTY ST
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City | WAUCONDA
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State | IL
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Zip | 60084-1929
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Country | US
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Telephone | 847-477-6465
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARK J GOULD
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Credential | DC
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Telephone | 847-469-8260
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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 |
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License Number State | IL
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