Provider Demographics
NPI:1710426796
Name:WELLNESS INSTITUTE OF ILLINOIS, LTD
Entity Type:Organization
Organization Name:WELLNESS INSTITUTE OF ILLINOIS, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:LAVINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-477-8844
Mailing Address - Street 1:110 HILLCREST BLVD SUITE 102
Mailing Address - Street 2:
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60195
Mailing Address - Country:US
Mailing Address - Phone:815-477-8844
Mailing Address - Fax:815-308-3387
Practice Address - Street 1:110 HILLCREST BLVD SUITE 102
Practice Address - Street 2:
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60195
Practice Address - Country:US
Practice Address - Phone:815-477-8844
Practice Address - Fax:815-308-3387
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-23
Last Update Date:2017-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site