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General NPI Number Information
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NPI Number | 1871915769
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Entity Type | Organization
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Legal Business Name | JC REJUVENATION AND WELLNESS LTD
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Dates
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Enumeration Date | 01/10/2014
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Last Update Date | 12/12/2014
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Provider Practice Location Address
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Address Line | 825 S ILLINOIS ROUTE 59
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City | BARTLETT
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State | IL
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Zip | 60103-1629
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Country | US
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Telephone | 630-289-1181
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Fax | 630-289-1186
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Provider Business Mailing Address
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Address Line | 825 S ILLINOIS ROUTE 59
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City | BARTLETT
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State | IL
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Zip | 60103-1629
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Country | US
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Telephone | 630-289-1811
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Fax | 630-289-1186
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | JEFFREY WITEK
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Credential | D.C.
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Telephone | 773-615-4334
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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 | 038.012557
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License Number State | IL
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