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General NPI Number Information
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NPI Number | 1316420763
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Entity Type | Organization
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Legal Business Name | WEST SUBURBAN WELLNESS OF OAK BROOK, LLC.
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Dates
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Enumeration Date | 09/12/2018
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Last Update Date | 10/30/2018
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Provider Practice Location Address
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Address Line | 1100 JORIE BLVD STE 318
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City | OAK BROOK
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State | IL
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Zip | 60523-2242
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Country | US
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Telephone | 630-629-9500
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Fax |
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Provider Business Mailing Address
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Address Line | 1100 JORIE BLVD STE 318
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City | OAK BROOK
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State | IL
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Zip | 60523-2242
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. TIMOTHY CHARLES WESELAK
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Credential | D.C.
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Telephone | 630-629-9500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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