Basic Information
| Provider Information | |||||||||
| NPI: | 1285024844 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DOWNERS GROVE TOTAL HEALTH SC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3000 WOODCREEK DR | ||||||||
| Address2: | SUITE 120 | ||||||||
| City: | DOWNERS GROVE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605155401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6305193239 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3000 WOODCREEK DR | ||||||||
| Address2: | SUITE 120 | ||||||||
| City: | DOWNERS GROVE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605155401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6305193239 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/03/2015 | ||||||||
| LastUpdateDate: | 02/03/2015 | ||||||||
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| AuthorizedOfficialLastName: | DOERSAM | ||||||||
| AuthorizedOfficialFirstName: | CHRIS | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8155410414 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | DC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | IL | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | General Practice | 111N00000X | IL | Y | 193200000X MULTI-SPECIALTY GROUP | Chiropractic Providers | Chiropractor |
No ID Information.