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General NPI Number Information
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NPI Number | 1922305721
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Entity Type | Organization
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Legal Business Name | WEST SUBURBAN WELLNESS
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Dates
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Enumeration Date | 02/15/2011
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Last Update Date | 02/15/2011
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Provider Practice Location Address
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Address Line | 1127 S MAIN ST
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City | LOMBARD
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State | IL
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Zip | 60148-3948
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Country | US
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Telephone | 630-629-9500
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Fax | 630-629-9501
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Provider Business Mailing Address
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Address Line | 1127 S MAIN ST
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City | LOMBARD
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State | IL
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Zip | 60148-3948
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Country | US
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Telephone | 630-629-9500
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Fax | 630-629-9501
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Authorized Official
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Title or Position | CHIROPRACTOR/CLINIC DIRECTOR
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Name | DR. TIMOTHY WESELAK
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Credential | DC
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Telephone | 630-629-9500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NN1001X
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Taxonomy Name | Nutrition Chiropractor
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License Number | 038.011472
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License Number State | IL
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