Healthcare Provider Details

I. General information

NPI: 1417999095
Provider Name (Legal Business Name): CHIRO ONE WELLNESS CENTER OF BOLINGBROOK LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2006
Last Update Date: 10/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

899 S WEBER RD SUITE D
BOLINGBROOK IL
60490-5488
US

IV. Provider business mailing address

2625 BUTTERFIELD RD SUITE 301N
OAK BROOK IL
60523-1234
US

V. Phone/Fax

Practice location:
  • Phone: 630-771-9496
  • Fax: 630-771-0361
Mailing address:
  • Phone: 630-468-1824
  • Fax: 630-320-6489

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. SAM WANG
Title or Position: COO
Credential: DC
Phone: 630-468-1824