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General NPI Number Information
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NPI Number | 1922468495
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Entity Type | Organization
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Legal Business Name | WOLF CREEK MEDICAL SOLUTIONS, LTD
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Dates
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Enumeration Date | 02/26/2016
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Last Update Date | 02/26/2016
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Provider Practice Location Address
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Address Line | 67 WOLF CREEK DR
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City | SWANSEA
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State | IL
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Zip | 62226-2355
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Country | US
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Telephone | 618-236-3600
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Fax |
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Provider Business Mailing Address
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Address Line | 67 WOLF CREEK DR
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City | SWANSEA
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State | IL
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Zip | 62226-2355
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Country | US
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Telephone | 618-236-3600
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | PATRICK KOMESHAK
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Credential | DC
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Telephone | 618-236-3600
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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 | 038-008047
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License Number State | IL
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