Provider Demographics
NPI:1013304674
Name:ADVANTAGE CHIROPRACTIC WELLNESS, LLC
Entity type:Organization
Organization Name:ADVANTAGE CHIROPRACTIC WELLNESS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALECIA
Authorized Official - Middle Name:
Authorized Official - Last Name:ARN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:815-389-7911
Mailing Address - Street 1:5069 EDGEMERE CT
Mailing Address - Street 2:
Mailing Address - City:ROSCOE
Mailing Address - State:IL
Mailing Address - Zip Code:61073-8800
Mailing Address - Country:US
Mailing Address - Phone:815-623-1013
Mailing Address - Fax:815-623-1017
Practice Address - Street 1:5069 EDGEMERE CT
Practice Address - Street 2:
Practice Address - City:ROSCOE
Practice Address - State:IL
Practice Address - Zip Code:61073-8800
Practice Address - Country:US
Practice Address - Phone:815-623-1013
Practice Address - Fax:815-623-1017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-22
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038009022111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty