Provider Demographics
NPI:1891997193
Name:ALIGN WELLNESS CENTER, P.C
Entity Type:Organization
Organization Name:ALIGN WELLNESS CENTER, P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGG
Authorized Official - Middle Name:P
Authorized Official - Last Name:GERSTIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:847-569-9500
Mailing Address - Street 1:300 SKOKIE BLVD
Mailing Address - Street 2:SUITE L
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062
Mailing Address - Country:US
Mailing Address - Phone:847-564-9500
Mailing Address - Fax:847-564-0486
Practice Address - Street 1:300 SKOKIE BLVD
Practice Address - Street 2:SUITE L
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062
Practice Address - Country:US
Practice Address - Phone:847-564-9500
Practice Address - Fax:847-564-0486
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-31
Last Update Date:2009-02-03
Deactivation Date:2008-08-05
Deactivation Code:
Reactivation Date:2009-02-03
Provider Licenses
StateLicense IDTaxonomies
IL038-010064111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL214119Medicare PIN
ILV08747Medicare UPIN
IL214119Medicare ID - Type Unspecified