Provider Demographics
NPI:1881904290
Name:COMPLETE CHIROPRACTIC AND WELLNESS CENTER LTD
Entity type:Organization
Organization Name:COMPLETE CHIROPRACTIC AND WELLNESS CENTER LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:ALEXANDER
Authorized Official - Last Name:SKAGGS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:815-729-2490
Mailing Address - Street 1:1226 PLAINFIELD RD
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-4024
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:815-729-2151
Practice Address - Street 1:1226 PLAINFIELD RD
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-4024
Practice Address - Country:US
Practice Address - Phone:815-729-2490
Practice Address - Fax:815-729-2151
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-19
Last Update Date:2010-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038011759111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty