Provider Demographics
NPI:1164686408
Name:CHIRO ONE WELLNESS CENTER OF TATES CREEK PLLC
Entity Type:Organization
Organization Name:CHIRO ONE WELLNESS CENTER OF TATES CREEK PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:DR
Authorized Official - First Name:SAM
Authorized Official - Middle Name:
Authorized Official - Last Name:WANG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:630-468-1824
Mailing Address - Street 1:3482 SOLUTIONS CTR
Mailing Address - Street 2:773482
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-0001
Mailing Address - Country:US
Mailing Address - Phone:630-320-6400
Mailing Address - Fax:630-320-6489
Practice Address - Street 1:4250 SARON DR
Practice Address - Street 2:SUITE 175
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40515-6483
Practice Address - Country:US
Practice Address - Phone:859-273-0310
Practice Address - Fax:859-273-0330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-16
Last Update Date:2012-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty