MEDICARE: CHIRO ONE WELLNESS CENTER OF ORLAND HILLS 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	1636647	OTHER	IL	BCBS

General Provider Information

NPI Number	:	1972690139
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHIRO ONE WELLNESS CENTER OF ORLAND HILLS 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	:	630-468-1824
Fax Number	:

Provider Business Practice Location Address
First Line	:	9121 159TH ST
Second Line	:	SUITE J-K
City	:	ORLAND HILLS
State	:	IL
Zip	:	60487-5901
Country	:	US
Telephone Number	:	708-675-1400
Fax Number	:	708-675-1405

Authorized Official
Title or Position	:	COO
Name	:	DR. SAM WANG
Credential	:	D.C.
Telephone Number	:	630-468-1824

Provider Enumeration Date	:	10/09/2006
Last Update Date	:	12/27/2017

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