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NPI Code Detail

MEDICARE: WINDY CITY WELLNESS, SC

MEDICARE: WINDY CITY WELLNESS, SC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1111N00000XChiropractorIL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11634086OTHERILBLUE CROSS BLUE SHIELD

General Provider Information

NPI Number : 1285794297
Entity Type Code : Organization
Provider Name (Legal Business Name) : WINDY CITY WELLNESS, SC
Provider Business Mailing Address
First Line : 620 N CARLYLE LN
Second Line :
City : ARLINGTON HTS
State : IL
Zip : 60004-5751
Country : US
Telephone Number : 847-754-1946
Fax Number : 773-276-2803
Provider Business Practice Location Address
First Line : 1630 W DIVISION ST
Second Line :
City : CHICAGO
State : IL
Zip : 60622-3808
Country : US
Telephone Number : 773-276-2801
Fax Number : 773-276-2803
Authorized Official
Title or Position : PRESIDING OFFICER
Name : DR. MICHAEL ANTHONY PONTARELLI
Credential : D.C.
Telephone Number : 847-754-1946
Provider Enumeration Date : 12/11/2006
Last Update Date : 08/22/2020

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Directions to “WINDY CITY WELLNESS, SC ” Practice Location

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