Provider Demographics
NPI:1811010986
Name:PLANET CHIROPRACTIC
Entity Type:Organization
Organization Name:PLANET CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:AARON
Authorized Official - Last Name:WOLFE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:312-787-9999
Mailing Address - Street 1:939 W NORTH AVE
Mailing Address - Street 2:SUITE 880
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-7138
Mailing Address - Country:US
Mailing Address - Phone:312-787-9999
Mailing Address - Fax:312-787-9998
Practice Address - Street 1:939 W NORTH AVE
Practice Address - Street 2:SUITE 880
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-7138
Practice Address - Country:US
Practice Address - Phone:312-787-9999
Practice Address - Fax:312-787-9998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01633332OtherBLUE CROSS BLUE SHIELD