Healthcare Provider Details

I. General information

NPI: 1497595177
Provider Name (Legal Business Name): WELLNESS SOCIETY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2024
Last Update Date: 05/29/2024
Certification Date: 05/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17749 65TH AVE
TINLEY PARK IL
60477-4370
US

IV. Provider business mailing address

17749 65TH AVE
TINLEY PARK IL
60477-4370
US

V. Phone/Fax

Practice location:
  • Phone: 708-670-2576
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. BRANDON KORFEL
Title or Position: DOCTOR
Credential: DC
Phone: 586-350-6606