Provider Demographics
NPI:1376139154
Name:DRIVEN WELLNESS
Entity Type:Organization
Organization Name:DRIVEN WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:D.N L.AC.
Authorized Official - Prefix:
Authorized Official - First Name:ANTONIO
Authorized Official - Middle Name:
Authorized Official - Last Name:PUGLIESE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-308-8669
Mailing Address - Street 1:3535 ROSE ST UNIT A
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60131-2013
Mailing Address - Country:US
Mailing Address - Phone:847-233-0806
Mailing Address - Fax:
Practice Address - Street 1:3535 ROSE ST UNIT A
Practice Address - Street 2:
Practice Address - City:FRANKLIN PARK
Practice Address - State:IL
Practice Address - Zip Code:60131-2013
Practice Address - Country:US
Practice Address - Phone:847-233-0806
Practice Address - Fax:847-233-0453
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-16
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain