MEDICARE: DK WELLNESS INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QH0100X	Health Service Clinic/Center

General Provider Information

NPI Number	:	1992041941
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DK WELLNESS INC

Provider Business Mailing Address
First Line	:	1523 ESSINGTON RD
Second Line	:
City	:	JOLIET
State	:	IL
Zip	:	60435-2879
Country	:	US
Telephone Number	:	815-730-3750
Fax Number	:	815-846-6210

Provider Business Practice Location Address
First Line	:	1523 ESSINGTON RD
Second Line	:
City	:	JOLIET
State	:	IL
Zip	:	60435-2879
Country	:	US
Telephone Number	:	815-730-3750
Fax Number	:	815-846-6210

Authorized Official
Title or Position	:	BILLING
Name	:	KATIE WERNER
Credential	:	CPC CPMA
Telephone Number	:	630-261-9286

Provider Enumeration Date	:	12/19/2012
Last Update Date	:	07/09/2013

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Directions to “DK WELLNESS INC ” Practice Location

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