Healthcare Provider Details

I. General information

NPI: 1629458005
Provider Name (Legal Business Name): RIVERONE HEALTH & WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2015
Last Update Date: 06/29/2024
Certification Date: 05/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 N HAMMES AVE STE 107
JOLIET IL
60435-8119
US

IV. Provider business mailing address

333 N HAMMES AVE STE 107
JOLIET IL
60435-8119
US

V. Phone/Fax

Practice location:
  • Phone: 815-705-6246
  • Fax:
Mailing address:
  • Phone: 815-705-6246
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038012808
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number198001256
License Number StateIL

VIII. Authorized Official

Name: DR. HA-IL LEE
Title or Position: MEMBER/OWNER
Credential: DC, MSOM, LAC
Phone: 815-705-6246