Provider Demographics
NPI:1306250006
Name:BIRDSALL, JOHN (ND, LDN)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:
Last Name:BIRDSALL
Suffix:
Gender:M
Credentials:ND, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 NORTH SHORE DR
Mailing Address - Street 2:SUITE 120
Mailing Address - City:LAKE BLUFF
Mailing Address - State:IL
Mailing Address - Zip Code:60044-2243
Mailing Address - Country:US
Mailing Address - Phone:847-343-2001
Mailing Address - Fax:
Practice Address - Street 1:900 NORTH SHORE DR
Practice Address - Street 2:SUITE 120
Practice Address - City:LAKE BLUFF
Practice Address - State:IL
Practice Address - Zip Code:60044-2243
Practice Address - Country:US
Practice Address - Phone:847-343-2001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-20
Last Update Date:2016-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT099.0098042175F00000X
IL164.006907133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No133N00000XDietary & Nutritional Service ProvidersNutritionist