=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700671849
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ROOT II WELLNESS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/10/2025
-----------------------------------------------------
Last Update Date | 04/10/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10413 S ROBERTS RD
-----------------------------------------------------
City | PALOS HILLS
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60465-1931
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-599-9585
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12633 ROSEMARY LN
-----------------------------------------------------
City | PALOS PARK
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60464-2000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-456-2417
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. BROOKLYN WASHINGTON
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 847-456-2417
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------