Provider Demographics
NPI:1578956975
Name:CHRIS SCOTT WELLNESS
Entity Type:Organization
Organization Name:CHRIS SCOTT WELLNESS
Other - Org Name:CHRIS SCOTT WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SKYLER
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITENACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-977-3747
Mailing Address - Street 1:1752 WINDSOR RD STE 202
Mailing Address - Street 2:
Mailing Address - City:LOVES PARK
Mailing Address - State:IL
Mailing Address - Zip Code:61111-4276
Mailing Address - Country:US
Mailing Address - Phone:815-977-3747
Mailing Address - Fax:
Practice Address - Street 1:1752 WINDSOR RD STE 202
Practice Address - Street 2:
Practice Address - City:LOVES PARK
Practice Address - State:IL
Practice Address - Zip Code:61111-4276
Practice Address - Country:US
Practice Address - Phone:815-977-3747
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-09
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No224Y00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersClinical Exercise PhysiologistGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty