Provider Demographics
NPI:1497013148
Name:CHIROPRACTIC HEALTH & WELLNESS I, LLC
Entity Type:Organization
Organization Name:CHIROPRACTIC HEALTH & WELLNESS I, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:R
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:630-483-7246
Mailing Address - Street 1:1600 N MAIN ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-3145
Mailing Address - Country:US
Mailing Address - Phone:630-510-7799
Mailing Address - Fax:630-510-7746
Practice Address - Street 1:1600 N MAIN ST
Practice Address - Street 2:SUITE B
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-3145
Practice Address - Country:US
Practice Address - Phone:630-510-7799
Practice Address - Fax:630-510-7746
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-01
Last Update Date:2016-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038011200111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty