Provider Demographics
NPI:1487750048
Name:HOLISTIC CHIROPRACTIC & HEALING ARTS
Entity type:Organization
Organization Name:HOLISTIC CHIROPRACTIC & HEALING ARTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KENT
Authorized Official - Middle Name:
Authorized Official - Last Name:CHRISTIANSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:630-548-0700
Mailing Address - Street 1:229 W OGDEN AVE
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-3047
Mailing Address - Country:US
Mailing Address - Phone:630-548-0700
Mailing Address - Fax:630-548-9070
Practice Address - Street 1:229 W OGDEN AVE
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-3047
Practice Address - Country:US
Practice Address - Phone:630-548-0700
Practice Address - Fax:630-548-9070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2024-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-008040111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL215704Medicare Oscar/Certification
ILU65887Medicare UPIN
ILK45616Medicare PIN