Healthcare Provider Details

I. General information

NPI: 1023636636
Provider Name (Legal Business Name): CHIRO ONE WELLNESS CENTER OF ELLISVILLE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2020
Last Update Date: 03/20/2023
Certification Date: 03/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15876 FOUNTAIN PLAZA DR
CHESTERFIELD MO
63017-7469
US

IV. Provider business mailing address

2625 BUTTERFIELD RD STE 301N
OAK BROOK IL
60523-1266
US

V. Phone/Fax

Practice location:
  • Phone: 630-468-1824
  • Fax:
Mailing address:
  • Phone: 630-468-1824
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: STUART BERNSEN
Title or Position: CEO
Credential:
Phone: 630-320-6400