Provider Demographics
NPI:1366926107
Name:RESTORE HEALTH AND WELLNESS PC
Entity type:Organization
Organization Name:RESTORE HEALTH AND WELLNESS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:BONAREK
Authorized Official - Last Name:LUKSA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:708-408-1957
Mailing Address - Street 1:25101 LIBERTY GROVE BLVD
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60544-2589
Mailing Address - Country:US
Mailing Address - Phone:708-408-1957
Mailing Address - Fax:
Practice Address - Street 1:23819 W MILL ST
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60544-3457
Practice Address - Country:US
Practice Address - Phone:708-625-6652
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RESTORE HEALTH AND WELLNESS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-09-18
Last Update Date:2018-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1295147452OtherCHIROPRACTOR