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General NPI Number Information
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NPI Number | 1912390030
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Entity Type | Organization
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Legal Business Name | LONE STAR CHIROPRACTIC AND WELLNESS CENTER LLC
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Dates
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Enumeration Date | 03/13/2015
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Last Update Date | 03/13/2015
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Provider Practice Location Address
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Address Line | 852 SHARP DR UNIT J
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City | SHOREWOOD
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State | IL
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Zip | 60404-8843
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Country | US
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Telephone | 815-341-5327
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Fax |
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Provider Business Mailing Address
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Address Line | 4319 TIMBER RIDGE CT
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City | JOLIET
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State | IL
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Zip | 60431-1705
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JENNA A EWERS
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Credential | D.C.
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Telephone | 815-341-5327
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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 | 038012568
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License Number State | IL
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