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General NPI Number Information
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NPI Number | 1154666386
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Entity Type | Organization
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Legal Business Name | SELECT WELLNESS CHIROPRACTIC, LLC
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Dates
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Enumeration Date | 11/28/2012
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Last Update Date | 11/28/2012
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Provider Practice Location Address
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Address Line | 300 SKOKIE BLVD SUITE L
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City | NORTHBROOK
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State | IL
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Zip | 60062-1625
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Country | US
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Telephone | 224-235-4985
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Fax |
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Provider Business Mailing Address
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Address Line | 300 SKOKIE BLVD SUITE L
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City | NORTHBROOK
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State | IL
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Zip | 60062-1625
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Country | US
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Telephone | 224-235-4985
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Fax |
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Authorized Official
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Title or Position | PRINCIPAL OWNER
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Name | DR. JEFFREY WILLIAM LOUIS
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Credential | D.C.
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Telephone | 224-235-4985
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 038012084
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License Number State | IL
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