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Organization
KETAMINE WELLNESS CENTERS CHICAGO
Active
Organization
KETAMINE WELLNESS CENTERS CHICAGO
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANITA D JERGER (EXECUTIVE ASSISTANT)
(855) 538-9355
Entity
Organization
Contact information
Practice address
603 E DIEHL RD, NAPERVILLE, IL 60563-1452
(855) 538-9355
(844) 538-9355
Mailing address
603 E DIEHL RD STE 139, NAPERVILLE, IL 60563-4905
(855) 538-9355
(844) 538-9355
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
—
NULL
163W00000X
Registered Nurse
—
—
207L00000X
Anesthesiology Physician
Primary
—
NULL
207L00000X
Anesthesiology Physician
Primary
—
—
207LP2900X
Pain Medicine (Anesthesiology) Physician
—
NULL
207LP2900X
Pain Medicine (Anesthesiology) Physician
—
—
Other
Enumeration date
01/08/2020
Last updated
08/15/2022
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