Healthcare Provider Details

I. General information

NPI: 1699244848
Provider Name (Legal Business Name): ADVANCED SPORT AND WELLNESS LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2018
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1776 S NAPERVILLE RD STE 200
WHEATON IL
60189-5831
US

IV. Provider business mailing address

1776 S NAPERVILLE RD STE 200
WHEATON IL
60189-5831
US

V. Phone/Fax

Practice location:
  • Phone: 630-791-0058
  • Fax:
Mailing address:
  • Phone: 630-791-0058
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: CHRISTOPHER KUDYBA
Title or Position: CHIROPRACTOR
Credential: D.C.
Phone: 630-791-0058