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General NPI Number Information
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NPI Number | 1992576359
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Entity Type | Organization
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Legal Business Name | LONGEVITY STRENGTH AND WELLNESS CENTER LLC
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Dates
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Enumeration Date | 01/12/2024
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Last Update Date | 01/12/2024
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Provider Practice Location Address
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Address Line | 4N525 HUNTER CT
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City | SAINT CHARLES
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State | IL
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Zip | 60175-7920
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Country | US
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Telephone | 847-721-4966
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Fax |
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Provider Business Mailing Address
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Address Line | 4N525 HUNTER CT
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City | SAINT CHARLES
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State | IL
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Zip | 60175-7920
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Country | US
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Telephone | 847-721-4966
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Fax |
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Authorized Official
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Title or Position | CHIROPRACTIC PHYSICIAN
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Name | DR. COLTON ANDERSON
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Credential | DC
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Telephone | 847-721-4977
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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 |
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License Number State |
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