Provider Demographics
NPI:1629270954
Name:HEALTH ON EARTH WELLNESS CENTERS LLC
Entity Type:Organization
Organization Name:HEALTH ON EARTH WELLNESS CENTERS LLC
Other - Org Name:CRESTWOOD CHIROPRACTIC AND REHAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:
Authorized Official - Last Name:VAUGHT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:708-396-2500
Mailing Address - Street 1:11933 S PULASKI RD STE C
Mailing Address - Street 2:
Mailing Address - City:ALSIP
Mailing Address - State:IL
Mailing Address - Zip Code:60803-1100
Mailing Address - Country:US
Mailing Address - Phone:314-704-5959
Mailing Address - Fax:708-396-8605
Practice Address - Street 1:13657 S. CICERO AVE
Practice Address - Street 2:
Practice Address - City:CRESTWOOD
Practice Address - State:IL
Practice Address - Zip Code:60445-1936
Practice Address - Country:US
Practice Address - Phone:708-396-2500
Practice Address - Fax:708-396-8605
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-31
Last Update Date:2022-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038010171111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty