Provider Demographics
NPI:1093066003
Name:EQUILIBRIUM HEALTH AND WELLNESS, LLC
Entity Type:Organization
Organization Name:EQUILIBRIUM HEALTH AND WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:H
Authorized Official - Last Name:CHAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:312-344-1384
Mailing Address - Street 1:1509 S STATE ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60605-2804
Mailing Address - Country:US
Mailing Address - Phone:312-344-1384
Mailing Address - Fax:
Practice Address - Street 1:1509 S STATE ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60605-2804
Practice Address - Country:US
Practice Address - Phone:312-344-1384
Practice Address - Fax:312-344-1457
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-01
Last Update Date:2021-09-14
Deactivation Date:2021-08-31
Deactivation Code:
Reactivation Date:2021-09-14
Provider Licenses
StateLicense IDTaxonomies
IL038012068305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization