Organization
WHOLE BODY MEDICAL WELLNESS LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIM KIDNER (OWNER)
(815) 844-4631
Entity
Organization
Contact information
Practice address
402 N PLUM ST, PONTIAC, IL 61764-1817
(815) 844-4631
(815) 844-1942
Mailing address
402 N PLUM ST, PONTIAC, IL 61764-1817
(815) 844-4631
(815) 844-1942
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
—
—
363L00000X
Nurse Practitioner
—
—
Other
Enumeration date
02/06/2017
Last updated
02/06/2017
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