Organization Active NPI

Chiro One Wellness Center of Crystal Lake SC

  • Chiropractor
  • Crystal Lake, IL
National Provider Identifier
1124155098
Registry record updated Oct 30, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
Legal business name
CHIRO ONE WELLNESS CENTER OF CRYSTAL LAKE SC
Practice address
435 Angela LN Ste 12
Crystal Lake, IL 60014-1074
Phone
(815) 301-4200
Fax
(815) 301-4205
NPI assigned
Feb 27, 2007
Last updated
Oct 30, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 30, 2026

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

Authorized official

Name
Chris Roeh
Title
Evp, Cfo
Phone
(630) 468-1824

Specialties & licenses 1

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

Addresses

Primary practice location

435 Angela LN Ste 12
Crystal Lake, IL 60014-1074

Mailing address

814 Commerce Dr Ste 300
Oak Brook, IL 60523-8823
Phone (630) 468-1824

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070724000634 IL Part B Supplier - Clinic/Group Practice 5395846133 Receives reassigned benefits from 1 practitioner
Practice locations: Crystal Lake, IL

National Provider Directory

National Provider Directory

Locations

435 Angela Ln
Ste 12
Crystal Lake, IL 60014
Phone (815) 301-4200

435 Angela Ln
Ste 19
Crystal Lake, IL 60014
Phone (630) 771-0434

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1172534400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1793318400000",
    "number": "1124155098",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "814 COMMERCE DR STE 300",
            "city": "OAK BROOK",
            "state": "IL",
            "postal_code": "605238823",
            "telephone_number": "630-468-1824"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "435 ANGELA LN STE 12",
            "city": "CRYSTAL LAKE",
            "state": "IL",
            "postal_code": "600141074",
            "telephone_number": "815-301-4200",
            "fax_number": "815-301-4205"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHIRO ONE WELLNESS CENTER OF CRYSTAL LAKE SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-27",
        "last_updated": "2026-10-30",
        "certification_date": "2026-10-30",
        "status": "A",
        "authorized_official_last_name": "ROEH",
        "authorized_official_first_name": "CHRIS",
        "authorized_official_title_or_position": "EVP, CFO",
        "authorized_official_telephone_number": "630-468-1824"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Crystal Lake, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2026; 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.