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General NPI Number Information
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NPI Number | 1154930097
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Entity Type | Organization
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Legal Business Name | FOUNDATIONS SPINE AND WELL NECESSITIES LLC
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Dates
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Enumeration Date | 07/27/2020
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Last Update Date | 10/14/2020
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Provider Practice Location Address
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Address Line | 2070 N RAND RD STE AB
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City | PALATINE
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State | IL
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Zip | 60074-2595
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Country | US
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Telephone | 714-421-1974
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Fax |
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Provider Business Mailing Address
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Address Line | 601 DEEPWOOD RD
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City | BARRINGTON
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State | IL
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Zip | 60010-8611
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Country | US
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Telephone | 714-421-1974
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Fax |
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Authorized Official
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Title or Position | OWNER/LEAD CHIROPRACTOR
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Name | VARTAN CHAKALIAN
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Credential | DC
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Telephone | 714-421-1974
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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 |
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License Number State |
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