| Organization Name: | ILLINOIS WELLNESS GROUP OF JOLIET, LTD |
| NPI Number: | 1215342829 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | BRETT NOLAN NASH (OWNER) |
| Mailing Address: | 815 N Larkin Ave Suite 105 Joliet |
| State: | IL US |
| Postal Code: | 604353438 |
| Phone Number: | 8157142271 |
| Fax Number: | 8155823262 |
| NPI Enumeration Date: | 06/23/2014 |
| NPI Last Update Date: | 10/02/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |