Basic Information
| Provider Information | |||||||||
| NPI: | 1366408387 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ADVANCED MEDICAL & WELLNESS OF SPRING HILL, S.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 959 | ||||||||
| Address2: | |||||||||
| City: | DUNDEE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601180959 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 231 W MAIN ST | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | CARPENTERSVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601101788 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8474281515 | ||||||||
| FaxNumber: | 8474280024 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/26/2006 | ||||||||
| LastUpdateDate: | 05/14/2009 | ||||||||
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| AuthorizedOfficialLastName: | HORN | ||||||||
| AuthorizedOfficialFirstName: | DANIEL | ||||||||
| AuthorizedOfficialMiddleName: | P | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8474281515 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | ADVANCED MEDICAL & WELLNESS OF SPRING HILL, S.C. | ||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | D.C. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111N00000X | N | 193200000X MULTI-SPECIALTY GROUP | Chiropractic Providers | Chiropractor | 111NS0005X | N | 193200000X MULTI-SPECIALTY GROUP | Chiropractic Providers | Chiropractor | Sports Physician | 207Q00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | 2081P2900X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Pain Medicine |
No ID Information.