Chiro One Wellness Center Metro of West Addison LLC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

038009501 Issued in IL

Legal business name

CHIRO ONE WELLNESS CENTER METRO OF WEST ADDISON LLC

Practice address

2909 W Addison St
Chicago, IL 60618-4635

Phone

(630) 468-1824

NPI assigned

Apr 17, 2018

Last updated

Apr 17, 2018By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Sam Wang, DCNPI 1073520136

Title

Coo

Phone

(630) 468-1824

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Locations

Practitioners 2

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.

• Jacob Bernard Matrille, D.C.

  • Chiropractor
  • Chicago, IL
  • NPI 1891053534
  Medicare reassignment NPD
• Sam Wang, DC

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

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

{
    "created_epoch": "1523923200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1523923200000",
    "number": "1568959401",
    "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": "2909 W ADDISON ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606184635",
            "telephone_number": "630-468-1824"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHIRO ONE WELLNESS CENTER METRO OF WEST ADDISON LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-04-17",
        "last_updated": "2018-04-17",
        "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",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "IL",
            "license": "038009501",
            "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 Apr 17, 2018; 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.