Provider Demographics
NPI:1982909958
Name:HEALTH ON EARTH WELLNESS CENTERS SOUTH LOOP, LLC
Entity Type:Organization
Organization Name:HEALTH ON EARTH WELLNESS CENTERS SOUTH LOOP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:
Authorized Official - Last Name:VAUGHT
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:314-704-5959
Mailing Address - Street 1:7711 W 159TH ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60477-1329
Mailing Address - Country:US
Mailing Address - Phone:708-532-8080
Mailing Address - Fax:708-532-8383
Practice Address - Street 1:2334 S MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616-2105
Practice Address - Country:US
Practice Address - Phone:708-532-8080
Practice Address - Fax:708-532-8383
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-21
Last Update Date:2011-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty