Chiro One Wellness Center Metro of River North LLC

Primary specialty

ChiropractorTaxonomy code 111N00000X

Legal business name

CHIRO ONE WELLNESS CENTER METRO OF RIVER NORTH LLC

Practice address

712 N State St
Chicago, IL 60654-3820

Phone

(312) 564-5415

Fax

(312) 564-5418

NPI assigned

Feb 15, 2010

Organization subpart

No

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

Authorized official

Name

Sam Wang

Title

Coo

Phone

(630) 468-1824

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Locations

Practitioners 4

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

• Elliott James Jordan, D.C.

  • Chiropractor
  • Wheaton, IL
  • NPI 1285073379
  Medicare reassignment
• Mark Lagerkvist, D.C.

  • Chiropractor
  • Crystal Lake, IL
  • NPI 1578574604
  NPD (past)
• Gary Roeben, DC

  • Chiropractor
  • Oak Brook, IL
  • NPI 1447292750
  NPD (past)
• George Lee Walker, D.C.

  • Chiropractor
  • Chicago, IL
  • NPI 1134159551
  NPD (past)

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

{
    "created_epoch": "1266192000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1508803200000",
    "number": "1477875615",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2625 BUTTERFIELD RD STE 301N",
            "city": "OAK BROOK",
            "state": "IL",
            "postal_code": "605231266",
            "telephone_number": "630-468-1824"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "712 N STATE ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606543820",
            "telephone_number": "312-564-5415",
            "fax_number": "312-564-5418"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHIRO ONE WELLNESS CENTER METRO OF RIVER NORTH LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-02-15",
        "last_updated": "2017-10-24",
        "status": "A",
        "authorized_official_last_name": "WANG",
        "authorized_official_first_name": "SAM",
        "authorized_official_title_or_position": "COO",
        "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": []
}

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• Chiropractor in Chicago, IL
• Providers in Chicago, IL by specialty
• Chiropractor in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2017; 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.