Provider Demographics
NPI:1770460297
Name:CHIROSTRETCH1 INC
Entity type:Organization
Organization Name:CHIROSTRETCH1 INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:JERIES
Authorized Official - Middle Name:
Authorized Official - Last Name:JREISAT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:312-763-6542
Mailing Address - Street 1:47 E CHICAGO AVE STE 332B
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-5360
Mailing Address - Country:US
Mailing Address - Phone:312-763-6542
Mailing Address - Fax:
Practice Address - Street 1:47 E CHICAGO AVE STE 332B
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-5360
Practice Address - Country:US
Practice Address - Phone:312-763-6542
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-18
Last Update Date:2025-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty