Provider Demographics
NPI:1639350432
Name:COMPLETE WELLNESS CENTER, S.C,
Entity Type:Organization
Organization Name:COMPLETE WELLNESS CENTER, S.C,
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:GERITANO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:708-614-9800
Mailing Address - Street 1:7060 CENTENNIAL DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60477-1643
Mailing Address - Country:US
Mailing Address - Phone:708-614-9800
Mailing Address - Fax:708-614-9800
Practice Address - Street 1:7060 CENTENNIAL DR
Practice Address - Street 2:SUITE 102
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60477-1643
Practice Address - Country:US
Practice Address - Phone:708-614-9800
Practice Address - Fax:708-614-9800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-20
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01632592OtherBLUE CROSS &BLUE SHIELD
ILK05717Medicare UPIN