Provider Demographics
NPI:1588970651
Name:PATIENT FIRST, WELLNESS CENTER PC
Entity type:Organization
Organization Name:PATIENT FIRST, WELLNESS CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALBERTINA
Authorized Official - Middle Name:DARICE
Authorized Official - Last Name:LOGAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:630-705-1475
Mailing Address - Street 1:1S132 SUMMIT AVE
Mailing Address - Street 2:SUITE 307-308
Mailing Address - City:OAKBROOK TERRACE
Mailing Address - State:IL
Mailing Address - Zip Code:60181-3955
Mailing Address - Country:US
Mailing Address - Phone:630-705-1475
Mailing Address - Fax:630-705-1556
Practice Address - Street 1:1S132 SUMMIT AVE
Practice Address - Street 2:SUITE 307-308
Practice Address - City:OAKBROOK TERRACE
Practice Address - State:IL
Practice Address - Zip Code:60181-3955
Practice Address - Country:US
Practice Address - Phone:630-705-1475
Practice Address - Fax:630-705-1556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-26
Last Update Date:2012-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038010645111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty