Well-Rooted Functional Medicine
Clinic/Center, Medical Specialty in Woodstock, IL. Organization (NPI-2).
NPI number1205421237
StatusActive
Last updated in NPPESMar 2, 2021
Details
- NPI
- 1205421237
- Entity type
- Organization (NPI-2)
- Legal business name
- Well-Rooted Functional Medicine
- Organization subpart
- No
- Enumeration date
- Mar 2, 2021
- Certification date
- Mar 2, 2021
- Last updated
- Mar 2, 2021
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261QM2500X | Clinic/Center, Medical Specialty | – | – | Yes |
Practice location
110 S Johnson St Ste 207Woodstock, IL 60098-3259
Phone 815-355-1605
Mailing address
110 S Johnson St Ste 207Woodstock, IL 60098-3259
Phone 815-355-1605
Authorized official
Jessica Pawlicki
Owner
8155291201
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