Healthcare Provider Details

I. General information

NPI: 1881127900
Provider Name (Legal Business Name): CHIRO ONE WELLNESS CENTER OF HALES CORNERS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2017
Last Update Date: 05/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5305 S 108TH ST
HALES CORNERS WI
53130-1332
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 414-491-0096
  • Fax:
Mailing address:
  • Phone: 630-229-4430
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4407-12
License Number StateWI

VIII. Authorized Official

Name: DR. MATTHEW FRAHM
Title or Position: OWNER
Credential: DC
Phone: 414-491-0096