Provider Demographics
NPI:1619249216
Name:CENTER FOR WELLNESS, INC
Entity Type:Organization
Organization Name:CENTER FOR WELLNESS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ENGSTROM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:847-949-0063
Mailing Address - Street 1:700 N LAKE ST
Mailing Address - Street 2:STE 102
Mailing Address - City:MUNDELEIN
Mailing Address - State:IL
Mailing Address - Zip Code:60060-1357
Mailing Address - Country:US
Mailing Address - Phone:847-949-0063
Mailing Address - Fax:847-949-2663
Practice Address - Street 1:700 N LAKE ST
Practice Address - Street 2:STE 102
Practice Address - City:MUNDELEIN
Practice Address - State:IL
Practice Address - Zip Code:60060-1357
Practice Address - Country:US
Practice Address - Phone:847-949-0063
Practice Address - Fax:847-949-2663
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-30
Last Update Date:2020-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180000335101YP2500X
IL038011858111N00000X
IL038.011858111N00000X
IL198001049171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty