Provider Demographics
NPI:1629458005
Name:RIVERONE HEALTH & WELLNESS LLC
Entity Type:Organization
Organization Name:RIVERONE HEALTH & WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HA-IL
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DC, MSOM, LAC
Authorized Official - Phone:815-705-6246
Mailing Address - Street 1:333 N HAMMES AVE STE 107
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-8119
Mailing Address - Country:US
Mailing Address - Phone:815-705-6246
Mailing Address - Fax:
Practice Address - Street 1:333 N HAMMES AVE STE 107
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-8119
Practice Address - Country:US
Practice Address - Phone:815-705-6246
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-01
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038012808111N00000X
IL198001256171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty