Provider Demographics
NPI:1538257118
Name:DES MEDICAL CORP, S.C.
Entity type:Organization
Organization Name:DES MEDICAL CORP, S.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:LONGO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:847-259-6605
Mailing Address - Street 1:500 W CENTRAL RD
Mailing Address - Street 2:STE 101
Mailing Address - City:MT PROSPECT
Mailing Address - State:IL
Mailing Address - Zip Code:60056-2347
Mailing Address - Country:US
Mailing Address - Phone:847-259-6605
Mailing Address - Fax:847-259-8071
Practice Address - Street 1:500 W CENTRAL RD
Practice Address - Street 2:STE 101
Practice Address - City:MT PROSPECT
Practice Address - State:IL
Practice Address - Zip Code:60056-2347
Practice Address - Country:US
Practice Address - Phone:847-259-6605
Practice Address - Fax:847-259-8071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2015-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070-009859174400000X
IL038-008169111N00000X
IL174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty