Healthcare Provider Details

I. General information

NPI: 1588101364
Provider Name (Legal Business Name): JBS WELLNESS, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2017
Last Update Date: 01/31/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

731 S IL ROUTE 21 STE 140
GURNEE IL
60031-3812
US

IV. Provider business mailing address

731 S IL ROUTE 21 STE 140
GURNEE IL
60031
US

V. Phone/Fax

Practice location:
  • Phone: 847-680-9200
  • Fax: 847-680-9205
Mailing address:
  • Phone: 847-680-9200
  • Fax: 847-680-9205

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038.010912
License Number StateIL

VIII. Authorized Official

Name: MRS. JENNIFER JACKSON
Title or Position: OFFICE MANAGER
Credential:
Phone: 847-680-9200