Provider Demographics
NPI:1558518563
Name:CHIRO ONE WELLNESS CENTER OF ADDISON LLC
Entity Type:Organization
Organization Name:CHIRO ONE WELLNESS CENTER OF ADDISON LLC
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:PO BOX 5988
Mailing Address - Street 2:DEPT. 20-5034
Mailing Address - City:CAROL STREAM
Mailing Address - State:IL
Mailing Address - Zip Code:60197-5988
Mailing Address - Country:US
Mailing Address - Phone:630-320-6400
Mailing Address - Fax:630-320-6489
Practice Address - Street 1:1450 W LAKE ST
Practice Address - Street 2:SUITE #101
Practice Address - City:ADDISON
Practice Address - State:IL
Practice Address - Zip Code:60101-5767
Practice Address - Country:US
Practice Address - Phone:847-250-4810
Practice Address - Fax:847-250-4815
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-20
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty