Provider Demographics
NPI:1043289432
Name:WESELY FAMILY CHIROPRACTIC, P.C.
Entity Type:Organization
Organization Name:WESELY FAMILY CHIROPRACTIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:M
Authorized Official - Last Name:WESELY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:630-790-3335
Mailing Address - Street 1:800 ROOSEVELT RD
Mailing Address - Street 2:BLDG B SUITE 112
Mailing Address - City:GLEN ELLYN
Mailing Address - State:IL
Mailing Address - Zip Code:60137-5839
Mailing Address - Country:US
Mailing Address - Phone:630-790-3335
Mailing Address - Fax:630-790-3345
Practice Address - Street 1:800 ROOSEVELT RD
Practice Address - Street 2:BLDG B SUITE 112
Practice Address - City:GLEN ELLYN
Practice Address - State:IL
Practice Address - Zip Code:60137-5839
Practice Address - Country:US
Practice Address - Phone:630-790-3335
Practice Address - Fax:630-790-3345
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-16
Last Update Date:2013-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038009503111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL02232331OtherBCBSIL
IL02232331OtherBCBSIL