Provider Demographics
NPI:1083196596
Name:ESSENTIAL WELLNESS & PAIN CENTER, LTD
Entity Type:Organization
Organization Name:ESSENTIAL WELLNESS & PAIN CENTER, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RORY
Authorized Official - Middle Name:
Authorized Official - Last Name:MCKENNA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-669-4536
Mailing Address - Street 1:7231 W 103RD ST
Mailing Address - Street 2:
Mailing Address - City:PALOS HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60465-2064
Mailing Address - Country:US
Mailing Address - Phone:708-233-0022
Mailing Address - Fax:708-233-2322
Practice Address - Street 1:7231 W 103RD ST
Practice Address - Street 2:
Practice Address - City:PALOS HILLS
Practice Address - State:IL
Practice Address - Zip Code:60465-2064
Practice Address - Country:US
Practice Address - Phone:708-233-0022
Practice Address - Fax:708-233-2322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-30
Last Update Date:2018-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.017714363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty