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General NPI Number Information
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NPI Number | 1922573567
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Entity Type | Organization
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Legal Business Name | TRUE BLUE HEALTH & WELLNESS
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Dates
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Enumeration Date | 10/10/2018
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Last Update Date | 10/10/2018
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Provider Practice Location Address
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Address Line | 509 W OLD NORTHWEST HWY STE 100C
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City | BARRINGTON
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State | IL
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Zip | 60010-6816
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Country | US
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Telephone | 224-655-2044
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Fax |
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Provider Business Mailing Address
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Address Line | 509 W OLD NORTHWEST HWY STE 100C
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City | BARRINGTON
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State | IL
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Zip | 60010-6816
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | BROCK BUCHHOLZ
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Credential |
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Telephone | 847-951-6085
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QG0250X
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Taxonomy Name | Genetics Clinic/Center
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License Number |
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License Number State |
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