Provider Demographics
NPI:1194497362
Name:SUPERIOR HEALTH AND WELLNESS OF GURNEE, LTD
Entity type:Organization
Organization Name:SUPERIOR HEALTH AND WELLNESS OF GURNEE, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JODIE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:SCHULTZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:847-599-9900
Mailing Address - Street 1:495 N RIVERSIDE DR STE 102
Mailing Address - Street 2:
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-5919
Mailing Address - Country:US
Mailing Address - Phone:847-858-5759
Mailing Address - Fax:847-599-9901
Practice Address - Street 1:10105 74TH ST STE 103
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53142-7530
Practice Address - Country:US
Practice Address - Phone:847-858-5759
Practice Address - Fax:847-599-9901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-05
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty