NPIMap

Organization Active NPI

Wellness Revolution Lakeview LLC

Doing business as The Wellness Revolution Chiropractic and Acupuncture Center

  • Chiropractor
  • Chicago, IL
National Provider Identifier
1063920916
Registry record updated Aug 28, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
Legal business name
WELLNESS REVOLUTION LAKEVIEW LLC
Doing business as
The Wellness Revolution Chiropractic and Acupuncture Center
Practice address
3464 N Lincoln Ave # G1
Chicago, IL 60657-1173
Phone
(773) 348-6908
Fax
(224) 477-2617
NPI assigned
Jan 12, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 28, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Anthony Breitbach, DCNPI 1255400453
Title
Owner
Phone
(847) 869-1773

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111N00000X Primary

Addresses

Primary practice location

3464 N Lincoln Ave # G1
Chicago, IL 60657-1173

Mailing address

3464 N Lincoln Ave # G1
Chicago, IL 60657-1173
Phone (773) 348-6908

Other names 1

  • The Wellness Revolution Chiropractic and Acupuncture Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190104002001 IL Part B Supplier - Clinic/Group Practice 4486990967 Receives reassigned benefits from 4 practitioners
Practice locations: Chicago, IL

National Provider Directory

National Provider Directory

Locations

3464 N Lincoln Ave
#G1
Chicago, IL 60657
Phone (773) 348-6908

3259 N Ashland Ave
Chicago, IL 60657
Phone (773) 348-6908

Practitioners & affiliated clinicians

Practitioners 24

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 24

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1515715200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1756339200000",
    "number": "1063920916",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3464 N LINCOLN AVE # G1",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606571173",
            "telephone_number": "773-348-6908",
            "fax_number": "224-477-2617"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3464 N LINCOLN AVE # G1",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606571173",
            "telephone_number": "773-348-6908",
            "fax_number": "224-477-2617"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WELLNESS REVOLUTION LAKEVIEW LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-01-12",
        "last_updated": "2025-08-28",
        "certification_date": "2025-08-28",
        "status": "A",
        "authorized_official_last_name": "BREITBACH",
        "authorized_official_first_name": "ANTHONY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "847-869-1773",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Wellness Revolution Chiropractic and Acupuncture Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Chicago, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.