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General NPI Number Information
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NPI Number | 1508157348
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Entity Type | Organization
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Legal Business Name | WELLNESS CHICAGO COMPLEMENTARY MEDICAL CENTERS
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Dates
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Enumeration Date | 04/27/2011
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Last Update Date | 04/27/2011
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Provider Practice Location Address
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Address Line | 1101 LAKE ST SUITE 350
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City | OAK PARK
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State | IL
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Zip | 60301-1085
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Country | US
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Telephone | 312-467-0678
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Fax |
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Provider Business Mailing Address
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Address Line | 820 N ORLEANS ST SUITE 345
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City | CHICAGO
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State | IL
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Zip | 60610-3132
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Country | US
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Telephone | 312-467-0678
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. NANCY DIANNE DEARINGER
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Credential | D.C.
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Telephone | 312-467-0678
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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 | 038-005791
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License Number State | IL
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