Provider Demographics
NPI:1700516168
Name:ELEMENTAL WELLNESS CENTER LTD
Entity Type:Organization
Organization Name:ELEMENTAL WELLNESS CENTER LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTINS
Authorized Official - Middle Name:
Authorized Official - Last Name:ADEOYE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-553-0303
Mailing Address - Street 1:14484 JOHN HUMPHREY DR
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-2638
Mailing Address - Country:US
Mailing Address - Phone:708-364-0580
Mailing Address - Fax:708-364-0480
Practice Address - Street 1:14484 JOHN HUMPHREY DR
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-2638
Practice Address - Country:US
Practice Address - Phone:708-364-0580
Practice Address - Fax:708-364-0480
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-16
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083A0300XAllopathic & Osteopathic PhysiciansPreventive MedicineAddiction MedicineGroup - Single Specialty