Provider Demographics
NPI:1396393682
Name:NEUROLOGIC WELLNESS INSTITUTE, PLLC
Entity type:Organization
Organization Name:NEUROLOGIC WELLNESS INSTITUTE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:MICHALOPOULOS
Authorized Official - Suffix:
Authorized Official - Credentials:DC, DACNB, FABBIR
Authorized Official - Phone:630-766-1552
Mailing Address - Street 1:199 S ADDISON RD STE 106
Mailing Address - Street 2:
Mailing Address - City:WOOD DALE
Mailing Address - State:IL
Mailing Address - Zip Code:60191-1978
Mailing Address - Country:US
Mailing Address - Phone:630-766-1552
Mailing Address - Fax:
Practice Address - Street 1:160 E GRAND AVE # 200
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-3800
Practice Address - Country:US
Practice Address - Phone:630-766-1552
Practice Address - Fax:630-766-4220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-29
Last Update Date:2019-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN0400XChiropractic ProvidersChiropractorNeurologyGroup - Single Specialty