MEDICARE: DARBY WELLNESS INC

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	038012708	IL

General Provider Information

NPI Number	:	1942698964
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DARBY WELLNESS INC

Provider Business Mailing Address
First Line	:	800 S WELLS ST APT 1324
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60607-4541
Country	:	US
Telephone Number	:	312-635-9355
Fax Number	:

Provider Business Practice Location Address
First Line	:	800 S WELLS ST APT 1324
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60607-4541
Country	:	US
Telephone Number	:	312-635-9355
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	DR. JUANITA DARBY
Credential	:	D.C.
Telephone Number	:	312-635-9355

Provider Enumeration Date	:	12/29/2014
Last Update Date	:	12/29/2014

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