Provider Demographics
NPI:1912390030
Name:LONE STAR CHIROPRACTIC AND WELLNESS CENTER LLC
Entity Type:Organization
Organization Name:LONE STAR CHIROPRACTIC AND WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNA
Authorized Official - Middle Name:A
Authorized Official - Last Name:EWERS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:815-341-5327
Mailing Address - Street 1:4319 TIMBER RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60431-1705
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:852 SHARP DR
Practice Address - Street 2:UNIT J
Practice Address - City:SHOREWOOD
Practice Address - State:IL
Practice Address - Zip Code:60404-8843
Practice Address - Country:US
Practice Address - Phone:815-341-5327
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-13
Last Update Date:2015-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038012568111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty