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General NPI Number Information
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NPI Number | 1649872003
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Entity Type | Organization
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Legal Business Name | WITHANIA NATURAL HEALTH, SC
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Dates
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Enumeration Date | 11/11/2020
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Last Update Date | 11/11/2020
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Provider Practice Location Address
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Address Line | 820 E TERRA COTTA AVE STE 215
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City | CRYSTAL LAKE
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State | IL
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Zip | 60014-3646
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Country | US
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Telephone | 779-220-0208
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Fax | 779-220-0849
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Provider Business Mailing Address
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Address Line | 820 E TERRA COTTA AVE STE 215
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City | CRYSTAL LAKE
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State | IL
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Zip | 60014-3646
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Country | US
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Telephone | 779-220-0208
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Fax | 779-220-0849
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Authorized Official
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Title or Position | OWNER, PHYSICIAN
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Name | DR. KELSEY LOUISE BOTTERMAN
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Credential | DC, ND
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Telephone | 779-220-0208
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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 |
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