Provider Demographics
NPI:1306193321
Name:WHEATON CHIROPRACTIC SPINE & JOINT CENTER LLC
Entity Type:Organization
Organization Name:WHEATON CHIROPRACTIC SPINE & JOINT CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:HALLUMS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:630-510-7774
Mailing Address - Street 1:316 W ROOSEVELT ROAD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187
Mailing Address - Country:US
Mailing Address - Phone:312-636-8509
Mailing Address - Fax:
Practice Address - Street 1:316 W ROOSEVELT ROAD
Practice Address - Street 2:SUITE 100
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187
Practice Address - Country:US
Practice Address - Phone:312-636-8509
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-08
Last Update Date:2019-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038011112111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty