Provider Demographics
NPI:1548980667
Name:PROSPERIAN LLC
Entity type:Organization
Organization Name:PROSPERIAN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:KISELKA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:312-285-8822
Mailing Address - Street 1:1S132 SUMMIT AVE STE 307B
Mailing Address - Street 2:
Mailing Address - City:OAKBROOK TERRACE
Mailing Address - State:IL
Mailing Address - Zip Code:60181-3942
Mailing Address - Country:US
Mailing Address - Phone:773-848-2302
Mailing Address - Fax:
Practice Address - Street 1:1S132 SUMMIT AVE STE 307B
Practice Address - Street 2:
Practice Address - City:OAKBROOK TERRACE
Practice Address - State:IL
Practice Address - Zip Code:60181-3942
Practice Address - Country:US
Practice Address - Phone:773-848-2302
Practice Address - Fax:708-613-8880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-30
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NI0900XChiropractic ProvidersChiropractorInternistGroup - Multi-Specialty