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General NPI Number Information
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NPI Number | 1831597194
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Entity Type | Organization
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Legal Business Name | ADVANCED WELLNESS MEDICAL, LLC
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Dates
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Enumeration Date | 12/18/2014
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Last Update Date | 04/02/2015
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Provider Practice Location Address
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Address Line | 6325 MAIN STREET SUITE 120
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City | WOODRIDGE
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State | IL
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Zip | 60517
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Country | US
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Telephone | 630-541-6773
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Fax |
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Provider Business Mailing Address
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Address Line | 604 HOBSON RD.
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City | NAPERVILLE
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State | IL
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Zip | 60540
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Country | US
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Telephone | 630-542-2598
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Fax |
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Authorized Official
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Title or Position | OWNER/D.C
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Name | DR. EMMY WANG
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Credential | D.C.
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Telephone | 630-542-2598
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State | IL
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