Provider Demographics
NPI:1487667309
Name:NORTHERN LIGHT CARE, INC
Entity type:Organization
Organization Name:NORTHERN LIGHT CARE, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:
Authorized Official - Last Name:NORTHERN
Authorized Official - Suffix:
Authorized Official - Credentials:DC, CACCP
Authorized Official - Phone:815-344-0113
Mailing Address - Street 1:2302 W JOHNSBURG RD UNIT 1
Mailing Address - Street 2:
Mailing Address - City:JOHNSBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60051-5212
Mailing Address - Country:US
Mailing Address - Phone:815-344-0113
Mailing Address - Fax:815-344-8124
Practice Address - Street 1:2302 W JOHNSBURG RD UNIT 1
Practice Address - Street 2:
Practice Address - City:JOHNSBURG
Practice Address - State:IL
Practice Address - Zip Code:60051-5212
Practice Address - Country:US
Practice Address - Phone:815-344-0113
Practice Address - Fax:815-344-8124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-14
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-010000111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL208408Medicare ID - Type UnspecifiedMEDICARE
IL207459Medicare ID - Type UnspecifiedMEDICARE