Chiro One Wellness Center of Evergreen Park LLC

Primary specialty

ChiropractorTaxonomy code 111N00000X

Legal business name

CHIRO ONE WELLNESS CENTER OF EVERGREEN PARK LLC

Practice address

9715 S Western Ave
Chicago, IL 60643-1723

Phone

(630) 468-1824

NPI assigned

Aug 23, 2019

Organization subpart

No

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

Authorized official

Name

Stuart Bernsen, DC

Title

Ceo

Phone

(630) 468-1824

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Locations

Practitioners 3

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

• Robert E Butt, D.C.

  • Chiropractor
  • Oak Lawn, IL
  • NPI 1295881639
  Medicare reassignment Care Compare group NPD
• Driesen Evans, DC

  • Chiropractor
  • Chicago, IL
  • NPI 1952271397
  Medicare reassignment Care Compare group NPD
• Sam Wang, DC

  • Chiropractor
  • Libertyville, IL
  • NPI 1073520136
  NPD (past)

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

{
    "created_epoch": "1566518400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1566518400000",
    "number": "1548817547",
    "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": "9715 S WESTERN AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606431723",
            "telephone_number": "630-468-1824"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHIRO ONE WELLNESS CENTER OF EVERGREEN PARK LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-08-23",
        "last_updated": "2019-08-23",
        "status": "A",
        "authorized_official_last_name": "BERNSEN",
        "authorized_official_first_name": "STUART",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "630-468-1824",
        "authorized_official_credential": "DC"
    },
    "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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• Chiro360 PLLC
• Chiro4Health, PC

• 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 Aug 23, 2019; 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.