Provider Demographics
NPI:1215166392
Name:HAWTHORN MEDICAL S C
Entity type:Organization
Organization Name:HAWTHORN MEDICAL S C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:R
Authorized Official - Last Name:MATTSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:847-932-1079
Mailing Address - Street 1:977 LAKEVIEW PKWY
Mailing Address - Street 2:SUITE 103
Mailing Address - City:VERNON HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60061-1400
Mailing Address - Country:US
Mailing Address - Phone:847-932-1079
Mailing Address - Fax:847-932-1082
Practice Address - Street 1:977 LAKEVIEW PKWY
Practice Address - Street 2:SUITE 103
Practice Address - City:VERNON HILLS
Practice Address - State:IL
Practice Address - Zip Code:60061-1400
Practice Address - Country:US
Practice Address - Phone:847-932-1079
Practice Address - Fax:847-932-1082
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-09
Last Update Date:2009-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038006727111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty