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NPI Code Detail

MEDICARE: CHIRO ONE WELLNESS CENTER OF MILL POND PLLC

MEDICARE: CHIRO ONE WELLNESS CENTER OF MILL POND PLLC
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
1111N00000XChiropractor

General Provider Information

NPI Number : 1366606501
Entity Type Code : Organization
Provider Name (Legal Business Name) : CHIRO ONE WELLNESS CENTER OF MILL POND PLLC
Provider Business Mailing Address
First Line : 3488 SOLUTIONS CTR
Second Line : 773488
City : CHICAGO
State : IL
Zip : 60677-0001
Country : US
Telephone Number : 630-320-6400
Fax Number : 630-320-6489
Provider Business Practice Location Address
First Line : 3801 DYLAN PL
Second Line : SUITE 110
City : LEXINGTON
State : KY
Zip : 40514-1062
Country : US
Telephone Number : 859-296-2313
Fax Number : 859-296-2399
Authorized Official
Title or Position : COO
Name : DR. SAM WANG
Credential : DC
Telephone Number : 630-468-1824
Provider Enumeration Date : 07/16/2008
Last Update Date : 11/09/2012

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Directions to “CHIRO ONE WELLNESS CENTER OF MILL POND PLLC ” Practice Location

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