Healthcare Provider Details

I. General information

NPI: 1750016226
Provider Name (Legal Business Name): CHIRO ONE WELLNESS CENTER OF ST CHARLES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2022
Last Update Date: 03/20/2023
Certification Date: 03/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1993 ZUMBEHL RD
SAINT CHARLES MO
63303-2725
US

IV. Provider business mailing address

PO BOX 74008519 PMB 1259
CHICAGO IL
60674-0001
US

V. Phone/Fax

Practice location:
  • Phone: 636-373-8338
  • Fax:
Mailing address:
  • Phone: 630-320-6400
  • Fax: 630-468-1478

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