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General NPI Number Information
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NPI Number | 1548532377
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Entity Type | Organization
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Legal Business Name | KRYSSAGE WELLNESS
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Dates
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Enumeration Date | 02/09/2012
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Last Update Date | 02/15/2012
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Provider Practice Location Address
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Address Line | 328 S. THIRD ST.
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City | GENEVA
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State | IL
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Zip | 60134-2772
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Country | US
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Telephone | 630-649-2864
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Fax |
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Provider Business Mailing Address
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Address Line | 402 E. WASHINGTON ST.
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City | WEST CHICAGO
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State | IL
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Zip | 60185-2232
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Country | US
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Telephone | 630-649-2864
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. KRYSIA RIAN-TSCHEREWIK
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Credential | LMT
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Telephone | 630-649-2864
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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 | 038.010540
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License Number State | IL
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