Provider Demographics
NPI:1710194295
Name:HEALTHSMART OF ILLINOIS, LTD.
Entity type:Organization
Organization Name:HEALTHSMART OF ILLINOIS, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARSHALL
Authorized Official - Middle Name:
Authorized Official - Last Name:DICKHOLTZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:847-272-1000
Mailing Address - Street 1:2565 SHERMER RD
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-6725
Mailing Address - Country:US
Mailing Address - Phone:847-272-1000
Mailing Address - Fax:847-272-9742
Practice Address - Street 1:2565 SHERMER RD
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-6725
Practice Address - Country:US
Practice Address - Phone:847-272-1000
Practice Address - Fax:847-272-9742
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL662870Medicare ID - Type Unspecified