Organization
JLDC INC.
Active
Other names
Optimal Spine Chiropractic
Organization subpart
No
Provider details
NPI number
Authorized official
DR. NATHAN E WIEDRICH DC (OWNER)
(843) 906-0090
Entity
Organization
Contact information
Practice address
2031 E GRAND AVE STE 301, LINDENHURST, IL 60046-9094
(843) 906-0090
(843) 906-0090
Mailing address
2031 E GRAND AVE STE 301, LINDENHURST, IL 60046-9094
(843) 906-0090
Taxonomy
Speciality
Code
Description
License number
State
111NR0400X
Rehabilitation Chiropractor
Primary
038.010896
IL
Other
Enumeration date
02/01/2018
Last updated
03/28/2018
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