Healthcare Provider Details

I. General information

NPI: 1710035183
Provider Name (Legal Business Name): WELLNESS REVOLUTION CHIROPRACTIC & ACUPUNCTURE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 06/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1117 EMERSON ST
EVANSTON IL
60201
US

IV. Provider business mailing address

1117 EMERSON ST
EVANSTON IL
60201-3131
US

V. Phone/Fax

Practice location:
  • Phone: 847-869-1773
  • Fax: 847-869-2733
Mailing address:
  • Phone: 847-869-1773
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. ANTHONY BREITBACH
Title or Position: PRESIDENT
Credential: DC
Phone: 847-869-1773