Provider Demographics
NPI:1700319639
Name:ULTIMATE SKILLS SPORTS AND WELLNESS LLC
Entity Type:Organization
Organization Name:ULTIMATE SKILLS SPORTS AND WELLNESS LLC
Other - Org Name:SPINE AND JOINT RELIEF CARE CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:ZAESKE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:708-429-7615
Mailing Address - Street 1:17500 DUVAN DR
Mailing Address - Street 2:
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60477-3671
Mailing Address - Country:US
Mailing Address - Phone:708-429-7615
Mailing Address - Fax:
Practice Address - Street 1:17500 DUVAN DR
Practice Address - Street 2:
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60477-3671
Practice Address - Country:US
Practice Address - Phone:708-429-7615
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-07
Last Update Date:2017-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-008716111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty