Provider Demographics
NPI:1992988125
Name:GAUTHIER HEALTH CENTER PC
Entity type:Organization
Organization Name:GAUTHIER HEALTH CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:W
Authorized Official - Last Name:GAUTHIER
Authorized Official - Suffix:III
Authorized Official - Credentials:DC
Authorized Official - Phone:630-682-8682
Mailing Address - Street 1:57 DANADA SQ E
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-8484
Mailing Address - Country:US
Mailing Address - Phone:630-682-8682
Mailing Address - Fax:630-681-8366
Practice Address - Street 1:57 DANADA SQ E
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-8484
Practice Address - Country:US
Practice Address - Phone:630-682-8682
Practice Address - Fax:630-681-8366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-11
Last Update Date:2014-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL2206151OtherBCBS
IL2206151OtherBCBS