NPIMap

Organization Active NPI

Shark's Eye Establishment Corp.

Doing business as Healthy Connection Wellness Center

  • Chiropractor
  • Lockport, IL
National Provider Identifier
1417268236
Registry record updated Mar 12, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
038009499 Issued in IL
Legal business name
SHARK'S EYE ESTABLISHMENT CORP.
Doing business as
Healthy Connection Wellness Center
Practice address
16626 W 159TH St
Suite 700
Lockport, IL 60441-8018
Phone
(815) 834-9075
Fax
(815) 834-9077
NPI assigned
Jun 25, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 12, 2013

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

Authorized official

Name
Victor Puodziunas
Title
Executive Director
Phone
(815) 834-9075

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111N00000X 038009499 IL Primary

Addresses

Primary practice location

16626 W 159TH St
Suite 700
Lockport, IL 60441-8018

Mailing address

16626 W 159TH St
Suite 700
Lockport, IL 60441-8018
Phone (815) 834-9075

Other names 1

  • Healthy Connection Wellness Center Doing business as

National Provider Directory

National Provider Directory

Locations

16547 W 159th St
Lockport, IL 60441
Phone (815) 834-9075

NPI Registry JSON

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

{
    "created_epoch": "1277424000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1363046400000",
    "number": "1417268236",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16626 W 159TH ST",
            "address_2": "SUITE 700",
            "city": "LOCKPORT",
            "state": "IL",
            "postal_code": "604418018",
            "telephone_number": "815-834-9075",
            "fax_number": "815-834-9077"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16626 W 159TH ST",
            "address_2": "SUITE 700",
            "city": "LOCKPORT",
            "state": "IL",
            "postal_code": "604418018",
            "telephone_number": "815-834-9075",
            "fax_number": "815-834-9077"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHARK'S EYE ESTABLISHMENT CORP.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-06-25",
        "last_updated": "2013-03-12",
        "status": "A",
        "authorized_official_last_name": "PUODZIUNAS",
        "authorized_official_first_name": "VICTOR",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "815-834-9075"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "IL",
            "license": "038009499",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Healthy Connection Wellness Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lockport, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2013; 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.