Provider Demographics
NPI:1720223035
Name:KO WELLNESS AND REHABILITATION CENTER INC
Entity Type:Organization
Organization Name:KO WELLNESS AND REHABILITATION CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLES
Authorized Official - Middle Name:
Authorized Official - Last Name:KO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:630-254-0581
Mailing Address - Street 1:715 ASTOR LN
Mailing Address - Street 2:#301
Mailing Address - City:WHEELING
Mailing Address - State:IL
Mailing Address - Zip Code:60090-6257
Mailing Address - Country:US
Mailing Address - Phone:630-254-0581
Mailing Address - Fax:
Practice Address - Street 1:715 ASTOR LN
Practice Address - Street 2:#301
Practice Address - City:WHEELING
Practice Address - State:IL
Practice Address - Zip Code:60090-6257
Practice Address - Country:US
Practice Address - Phone:630-254-0581
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-16
Last Update Date:2008-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038010090111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty