Healthcare Provider Details

I. General information

NPI: 1982847646
Provider Name (Legal Business Name): CHIRO ONE WELLNESS CENTER METRO OF SOUTH LOOP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2009
Last Update Date: 10/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 S CANAL ST STE 101
CHICAGO IL
60607-4901
US

IV. Provider business mailing address

2625 BUTTERFIELD RD STE 301N
OAK BROOK IL
60523-1266
US

V. Phone/Fax

Practice location:
  • Phone: 312-854-8500
  • Fax: 312-854-8505
Mailing address:
  • Phone: 630-468-1824
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

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