MEDICARE: CHIRO ONE WELLNESS CENTER OF VERNON HILLS 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
1	111N00000X	Chiropractor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4932806	OTHER	IL	BCBS

General Provider Information

NPI Number	:	1831378587
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHIRO ONE WELLNESS CENTER OF VERNON HILLS SC

Provider Business Mailing Address
First Line	:	2625 BUTTERFIELD RD
Second Line	:	STE 301N
City	:	OAK BROOK
State	:	IL
Zip	:	60523-1234
Country	:	US
Telephone Number	:	630-468-1824
Fax Number	:

Provider Business Practice Location Address
First Line	:	281 W TOWNLINE RD
Second Line	:	SUITE 200
City	:	VERNON HILLS
State	:	IL
Zip	:	60061-4334
Country	:	US
Telephone Number	:	224-207-4060
Fax Number	:	224-207-4065

Authorized Official
Title or Position	:	COO
Name	:	DR. SAM WANG
Credential	:	D.C.
Telephone Number	:	630-468-1824

Provider Enumeration Date	:	10/30/2007
Last Update Date	:	03/27/2018

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Directions to “CHIRO ONE WELLNESS CENTER OF VERNON HILLS SC ” Practice Location

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