NPIMap

Organization Active NPI

Equilibrium Health and Wellness, LLC

  • Preferred Provider Organization
  • Chicago, IL
National Provider Identifier
1093066003
Registry record updated Sep 14, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Preferred Provider OrganizationTaxonomy code 305R00000X
License
038012068 Issued in IL
Legal business name
EQUILIBRIUM HEALTH AND WELLNESS, LLC
Practice address
1509 S State St
Chicago, IL 60605-2804
Phone
(312) 344-1384
Fax
(312) 344-1457
NPI assigned
Oct 1, 2012
Reactivated
Sep 14, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 14, 2021

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

Authorized official

Name
Dr. Jessica H Chan, D.C.
Title
Chiropractor
Phone
(312) 344-1384

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Preferred Provider Organization 305R00000X 038012068 IL Primary

Addresses

Primary practice location

1509 S State St
Chicago, IL 60605-2804

Mailing address

1509 S State St
Chicago, IL 60605-2804
Phone (312) 344-1384

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 4

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

NPI Registry JSON

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

{
    "created_epoch": "1349049600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1631577600000",
    "number": "1093066003",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1509 S STATE ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606052804",
            "telephone_number": "312-344-1384"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1509 S STATE ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606052804",
            "telephone_number": "312-344-1384",
            "fax_number": "312-344-1457"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EQUILIBRIUM HEALTH AND WELLNESS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-01",
        "last_updated": "2021-09-14",
        "certification_date": "2021-09-14",
        "deactivation_date": "2021-08-31",
        "reactivation_date": "2021-09-14",
        "status": "A",
        "authorized_official_last_name": "CHAN",
        "authorized_official_first_name": "JESSICA",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "CHIROPRACTOR",
        "authorized_official_telephone_number": "312-344-1384",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "305R00000X",
            "taxonomy_group": "",
            "desc": "Preferred Provider Organization",
            "state": "IL",
            "license": "038012068",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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 Sep 14, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.