Provider Demographics
NPI:1477214831
Name:TOTAL ATHLETICARE 1, LLC
Entity Type:Organization
Organization Name:TOTAL ATHLETICARE 1, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:BENGTSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:847-706-9600
Mailing Address - Street 1:999 N PLAZA DR STE 115
Mailing Address - Street 2:
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60173-5403
Mailing Address - Country:US
Mailing Address - Phone:847-706-9600
Mailing Address - Fax:847-706-9610
Practice Address - Street 1:999 N PLAZA DR STE 115
Practice Address - Street 2:
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60173-5403
Practice Address - Country:US
Practice Address - Phone:847-706-9600
Practice Address - Fax:847-706-9610
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-06
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty