Healthcare Provider Details

I. General information

NPI: 1588609424
Provider Name (Legal Business Name): SAUGANASH WELLNESS CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2006
Last Update Date: 03/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6160 N CICERO AVE
CHICAGO IL
60646-4312
US

IV. Provider business mailing address

6160 N CICERO AVE
CHICAGO IL
60646-4312
US

V. Phone/Fax

Practice location:
  • Phone: 773-283-4470
  • Fax: 773-767-3944
Mailing address:
  • Phone: 773-283-4470
  • Fax: 773-767-3944

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: LYNN MCROY
Title or Position: BILLING COORDINATOR
Credential:
Phone: 773-767-3822