Basic Information
| Provider Information | |||||||||
| NPI: | 1689946725 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SUPERIORHEALTH & WELLNESS OF MCHENRY LTD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 202 FRONT ST | ||||||||
| Address2: | SOUTH RTE 31 | ||||||||
| City: | MCHENRY | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60050 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8153441192 | ||||||||
| FaxNumber: | 8153448070 | ||||||||
| Practice Location | |||||||||
| Address1: | 202 FRONT ST | ||||||||
| Address2: | SOUTH RTE 31 | ||||||||
| City: | MCHENRY | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60050 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8153441192 | ||||||||
| FaxNumber: | 8153448070 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/06/2012 | ||||||||
| LastUpdateDate: | 02/06/2012 | ||||||||
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| AuthorizedOfficialLastName: | HARTLETT | ||||||||
| AuthorizedOfficialFirstName: | TIMOTHY | ||||||||
| AuthorizedOfficialMiddleName: | JAMES | ||||||||
| AuthorizedOfficialTitleorPosition: | PRES. | ||||||||
| AuthorizedOfficialTelephone: | 8153441192 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| 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 | 363A00000X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363L00000X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 208100000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
No ID Information.