Healthcare Provider Details

I. General information

NPI: 1578791844
Provider Name (Legal Business Name): WELLNESS IN MOTION CHIROPRACTIC CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2009
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6580 N NORTHWEST HWY
CHICAGO IL
60631-1415
US

IV. Provider business mailing address

6580 N NORTHWEST HWY
CHICAGO IL
60631-1415
US

V. Phone/Fax

Practice location:
  • Phone: 708-220-6108
  • Fax:
Mailing address:
  • Phone: 708-220-6108
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. ANTHONY DANIEL CISTERNINO
Title or Position: PRESIDENT, SECRETARY
Credential: D.C.
Phone: 708-220-6108