Provider Demographics
NPI:1992361919
Name:WADE WELLNESS, INC.
Entity Type:Organization
Organization Name:WADE WELLNESS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ACUPUNCTURIST
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:WADE
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:773-406-2091
Mailing Address - Street 1:7238 W EVERELL AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60631-1933
Mailing Address - Country:US
Mailing Address - Phone:773-406-2091
Mailing Address - Fax:
Practice Address - Street 1:3817 N PULASKI RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60641-3141
Practice Address - Country:US
Practice Address - Phone:773-406-2091
Practice Address - Fax:312-971-1973
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-15
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty