Healthcare Provider Details

I. General information

NPI: 1457400277
Provider Name (Legal Business Name): CHIRO ONE WELLNESS CENTER OF SCHAUMBURG WEST CLINIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 06/08/2022
Certification Date: 06/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 S ROSELLE RD STE C
SCHAUMBURG IL
60193-5537
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 847-301-0499
  • Fax: 847-301-0419
Mailing address:
  • Phone: 630-229-4430
  • 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. SAM WANG
Title or Position: COO
Credential: D.C.
Phone: 630-229-4430