Provider Demographics
NPI:1891844049
Name:CHIRO ONE WELLNESS CENTER OF OLYMPIA FIELDS
Entity Type:Organization
Organization Name:CHIRO ONE WELLNESS CENTER OF OLYMPIA FIELDS
Other - Org Name:LIFEWORKS HEALTH CENTER OF CHICAGO SOUTHLAND
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:COO
Authorized Official - Prefix:DR
Authorized Official - First Name:SAM
Authorized Official - Middle Name:
Authorized Official - Last Name:WANG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:630-468-1824
Mailing Address - Street 1:2625 BUTTERFIELD RD
Mailing Address - Street 2:SUITE 301N
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-1234
Mailing Address - Country:US
Mailing Address - Phone:630-320-6400
Mailing Address - Fax:630-320-6489
Practice Address - Street 1:2446 LINCOLN HWY
Practice Address - Street 2:
Practice Address - City:OLYMPIA FIELDS
Practice Address - State:IL
Practice Address - Zip Code:60461-1904
Practice Address - Country:US
Practice Address - Phone:708-481-7722
Practice Address - Fax:708-481-7531
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2013-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1635670OtherBCBS
IL1635670OtherBCBS