Provider Demographics
NPI:1821375619
Name:CHIRO ONE WELLNESS CENTER METRO OF STREETERVILLE LLC
Entity type:Organization
Organization Name:CHIRO ONE WELLNESS CENTER METRO OF STREETERVILLE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:SAM
Authorized Official - Middle Name:
Authorized Official - Last Name:WANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-468-1824
Mailing Address - Street 1:PO BOX 5977
Mailing Address - Street 2:DEPT 20-3010
Mailing Address - City:CAROL STREAM
Mailing Address - State:IL
Mailing Address - Zip Code:60197-5977
Mailing Address - Country:US
Mailing Address - Phone:630-320-6400
Mailing Address - Fax:630-320-6489
Practice Address - Street 1:455 N CITYFRONT PLAZA DR
Practice Address - Street 2:STE 2040
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-5503
Practice Address - Country:US
Practice Address - Phone:312-262-6201
Practice Address - Fax:312-262-6202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-08
Last Update Date:2012-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty