Healthcare Provider Details

I. General information

NPI: 1720636996
Provider Name (Legal Business Name): MINX WELLNESS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2019
Last Update Date: 08/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2057 GREEN BAY RD STE A
HIGHLAND PARK IL
60035-6101
US

IV. Provider business mailing address

2057 GREEN BAY RD STE A
HIGHLAND PARK IL
60035-6101
US

V. Phone/Fax

Practice location:
  • Phone: 224-707-0572
  • Fax:
Mailing address:
  • Phone: 224-707-0572
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: EMMA MINX
Title or Position: CLINIC OWNER
Credential: DC
Phone: 847-502-2538