Organization
GREAT LAKES HEALTH & WELLNESS,SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARY PETERSON DC (PRESIDENT)
(708) 574-0736
Entity
Organization
Contact information
Practice address
7250 W COLLEGE DR STE 1SW, PALOS HEIGHTS, IL 60463-1393
(708) 371-6114
(708) 371-0816
Mailing address
7250 W COLLEGE DR STE 1SW, PALOS HEIGHTS, IL 60463-1393
(708) 371-6114
(708) 371-0816
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
038.008605
IL
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
038.008605
LICENSE
IL
Enumeration date
07/01/2008
Last updated
07/16/2024
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