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General NPI Number Information
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NPI Number | 1811266554
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Entity Type | Organization
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Legal Business Name | SUPERIOR HEALTH AND WELLNESS OF CRYSTAL LAKE, LTD.
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Dates
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Enumeration Date | 12/27/2011
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Last Update Date | 04/02/2015
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Provider Practice Location Address
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Address Line | 6119 NORTHWEST HWY STE B
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City | CRYSTAL LAKE
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State | IL
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Zip | 60014-7911
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Country | US
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Telephone | 815-477-8844
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Fax | 815-308-3387
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Provider Business Mailing Address
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Address Line | 6119-B NORTHWEST HIGHWAY
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City | CRYSTAL LAKE
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State | IL
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Zip | 60014
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Country | US
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Telephone | 815-477-8844
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Fax | 815-308-3387
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JILL E HOWE
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Credential | DC
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Telephone | 815-477-8844
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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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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State |
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