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General NPI Number Information
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NPI Number | 1699112102
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Entity Type | Organization
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Legal Business Name | DIRECT CARE WELLNESS, LLC
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Dates
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Enumeration Date | 05/24/2013
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Last Update Date | 12/27/2013
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Provider Practice Location Address
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Address Line | 3100 DUNDEE RD SUITE 504
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City | NORTHBROOK
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State | IL
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Zip | 60062-2437
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Country | US
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Telephone | 847-562-0840
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Fax | 847-562-0842
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Provider Business Mailing Address
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Address Line | 3100 DUNDEE RD SUITE 504
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City | NORTHBROOK
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State | IL
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Zip | 60062-2437
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Country | US
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Telephone | 847-562-0840
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Fax | 847-562-0842
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. HAL STUART STEIN
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Credential | DC
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Telephone | 847-562-0840
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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 | 038-007974
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 036092369
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License Number State | IL
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