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General NPI Number Information
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NPI Number | 1790280949
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Entity Type | Organization
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Legal Business Name | NORTHCENTER HEALTH AND WELLNESS, LLC
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Dates
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Enumeration Date | 03/29/2018
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Last Update Date | 03/29/2018
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Provider Practice Location Address
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Address Line | 4045 N DAMEN AVE STE 1
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City | CHICAGO
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State | IL
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Zip | 60618-3277
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Country | US
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Telephone | 773-296-2766
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Fax | 773-296-2768
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Provider Business Mailing Address
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Address Line | 4535 E LARCH AVE
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City | GLENVIEW
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State | IL
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Zip | 60025-1454
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Country | US
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Telephone | 847-208-6594
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Fax |
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Authorized Official
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Title or Position | OWNER/CHIROPRACTOR
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Name | DR. ANDY SUNGSOON PARK
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Credential | DC
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Telephone | 847-208-6594
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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 | 038.013059
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License Number State | IL
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