Crockett Wellness Clinic LLC

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

CROCKETT WELLNESS CLINIC LLC

Practice address

2829 Stonewater Dr
Naperville, IL 60564

Phone

(630) 454-1143

NPI assigned

Feb 23, 2022

Organization subpart

No

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

Authorized official

Name

Andre D Crockett, NDNPI 1659997690

Title

Managing Director

Phone

(331) 888-6505

Specialties & licenses 1

Addresses

Locations

Practitioners 1

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

• Andre D Crockett, NMD

  • Naturopath
  • Naperville, IL
  • NPI 1659997690
  NPD Authorized official

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

{
    "created_epoch": "1645574400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1645574400000",
    "number": "1487300935",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3075 BOOK RD UNIT 9155",
            "city": "NAPERVILLE",
            "state": "IL",
            "postal_code": "605671422",
            "telephone_number": "630-454-1143"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2829 STONEWATER DR",
            "city": "NAPERVILLE",
            "state": "IL",
            "postal_code": "60564",
            "telephone_number": "630-454-1143"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CROCKETT WELLNESS CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-02-23",
        "last_updated": "2022-02-23",
        "certification_date": "2022-02-05",
        "status": "A",
        "authorized_official_last_name": "CROCKETT",
        "authorized_official_first_name": "ANDRE",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "MANAGING DIRECTOR",
        "authorized_official_telephone_number": "331-888-6505",
        "authorized_official_credential": "ND"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Crescendo Counseling PLLC
• Crescent Primary Care Physicians PC
• Maximino Crespo-Deynes, L.P.C.
• Mary Ayres Crissman, B.S.
• Taniyah J Criswell, RBT
• Andre D Crockett, NMD
• Timothy Noel Crombie, D.D.S.
• Crossroads Community Counseling
• Stephen C Crotty, M.D.
• Gina Mercedes Crovetti, LCPC

• Clinic/Center in Naperville, IL
• Providers in Naperville, IL by specialty
• Clinic/Center in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2022; 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.