MEDICARE: CHIRO ONE WELLNESS CENTER OF GEIST LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor

General Provider Information

NPI Number	:	1003416942
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHIRO ONE WELLNESS CENTER OF GEIST LLC

Provider Business Mailing Address
First Line	:	2625 BUTTERFIELD RD STE 301N
Second Line	:
City	:	OAK BROOK
State	:	IL
Zip	:	60523-1266
Country	:	US
Telephone Number	:	630-468-1824
Fax Number	:

Provider Business Practice Location Address
First Line	:	11629 FOX RD
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46236-8422
Country	:	US
Telephone Number	:	317-823-5800
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	STUART BERNSEN
Credential	:	DC
Telephone Number	:	630-468-1824

Provider Enumeration Date	:	10/29/2020
Last Update Date	:	10/29/2020

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