Healthcare Provider Details

I. General information

NPI: 1023298510
Provider Name (Legal Business Name): CHIRO ONE WELLNESS CENTER OF HOMER GLEN, S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2007
Last Update Date: 07/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14142 S BELL RD UNIT B12
HOMER GLEN IL
60491-8465
US

IV. Provider business mailing address

2625 BUTTERFIELD RD STE 301N
OAK BROOK IL
60523-1234
US

V. Phone/Fax

Practice location:
  • Phone: 708-675-1190
  • Fax:
Mailing address:
  • Phone: 630-320-6400
  • Fax: 630-701-1007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. SAM WANG
Title or Position: C.O.O
Credential: D.C.
Phone: 630-468-1824