Provider Demographics
NPI:1922305721
Name:WEST SUBURBAN WELLNESS
Entity Type:Organization
Organization Name:WEST SUBURBAN WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/CLINIC DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:WESELAK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:630-629-9500
Mailing Address - Street 1:1127 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-3948
Mailing Address - Country:US
Mailing Address - Phone:630-629-9500
Mailing Address - Fax:630-629-9501
Practice Address - Street 1:1127 S MAIN ST
Practice Address - Street 2:
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-3948
Practice Address - Country:US
Practice Address - Phone:630-629-9500
Practice Address - Fax:630-629-9501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-15
Last Update Date:2011-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.011472111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN1001XChiropractic ProvidersChiropractorNutritionGroup - Single Specialty