MEDICARE: CHIRO ONE WELLNESS CENTER OF SCHAUMBURG WEST CLINIC, 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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1636757	OTHER	IL	BCBS

General Provider Information

NPI Number	:	1457400277
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHIRO ONE WELLNESS CENTER OF SCHAUMBURG WEST CLINIC, LLC

Provider Business Mailing Address
First Line	:	2625 BUTTERFIELD RD
Second Line	:	SUITE 301N
City	:	OAK BROOK
State	:	IL
Zip	:	60523-1234
Country	:	US
Telephone Number	:	630-229-4430
Fax Number	:

Provider Business Practice Location Address
First Line	:	160 S ROSELLE RD STE C
Second Line	:
City	:	SCHAUMBURG
State	:	IL
Zip	:	60193-5537
Country	:	US
Telephone Number	:	847-301-0499
Fax Number	:	847-301-0419

Authorized Official
Title or Position	:	COO
Name	:	DR. SAM WANG
Credential	:	D.C.
Telephone Number	:	630-229-4430

Provider Enumeration Date	:	01/10/2007
Last Update Date	:	06/08/2022

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