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General NPI Number Information
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NPI Number | 1093066003
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Entity Type | Organization
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Legal Business Name | EQUILIBRIUM HEALTH AND WELLNESS, LLC
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Dates
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Enumeration Date | 10/01/2012
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Last Update Date | 09/14/2021
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Provider Practice Location Address
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Address Line | 1509 S STATE ST
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City | CHICAGO
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State | IL
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Zip | 60605-2804
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Country | US
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Telephone | 312-344-1384
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Fax | 312-344-1457
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Provider Business Mailing Address
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Address Line | 1509 S STATE ST
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City | CHICAGO
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State | IL
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Zip | 60605-2804
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Country | US
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Telephone | 312-344-1384
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Fax |
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | DR. JESSICA H CHAN
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Credential | D.C.
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Telephone | 312-344-1384
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number | 038012068
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License Number State | IL
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