Provider Demographics
NPI:1851931109
Name:SPINE & WELLNESS CLINIC, INC.
Entity Type:Organization
Organization Name:SPINE & WELLNESS CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:DR
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:L
Authorized Official - Last Name:FLYNN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:224-436-8080
Mailing Address - Street 1:775 N BANK LANE SUITE 101
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60045
Mailing Address - Country:US
Mailing Address - Phone:224-436-8080
Mailing Address - Fax:
Practice Address - Street 1:775 N BANK LANE SUITE 101
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:IL
Practice Address - Zip Code:60045
Practice Address - Country:US
Practice Address - Phone:224-436-8080
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-14
Last Update Date:2020-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty