Healthcare Provider Details

I. General information

NPI: 1003125121
Provider Name (Legal Business Name): CHIRO ONE WELLNESS CENTER OF NICHOLASVILLE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2010
Last Update Date: 11/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

624 EDGEWOOD DR
NICHOLASVILLE KY
40356-2261
US

IV. Provider business mailing address

3786 SOLUTIONS CTR #773786
CHICAGO IL
60677-0001
US

V. Phone/Fax

Practice location:
  • Phone: 859-885-5020
  • Fax: 859-885-5050
Mailing address:
  • Phone: 630-320-6400
  • Fax: 630-320-6489

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: SAM WANG
Title or Position: COO
Credential:
Phone: 630-468-1824