Chiro One Wellness Center of Oak Forest LLC
Organization Active NPI Chiropractor · Oak Forest, IL
NPI 1649599291 · NPPES record last updated Oct 24, 2017
Key facts
- NPI
- 1649599291
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Chiropractor 111N00000X
- Legal business name
- CHIRO ONE WELLNESS CENTER OF OAK FOREST LLC
- Practice address
- 5424 159TH St
#32
Oak Forest, IL 60452-3248 - Phone
- (708) 577-5003
- Fax
- (708) 577-5006
- NPI assigned
- May 21, 2010
- Organization subpart
- No
Authorized official
- Name
- Sam Wang
- Title
- Coo
- Phone
- (630) 468-1824
Practitioners 6
-
Ronald L Berger, D.C.
-
Michelle Blanton, DC
-
Mark Lagerkvist, D.C.
-
Gary Roeben, DC
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100825000162 | IL | Part B Supplier - Clinic/Group Practice | 3173647385 |
Receives reassigned benefits from 3 practitioners Practice locations: Oak Forest, IL |
National Provider Directory
Locations
5424 159th St
Oak Forest, IL 60452
Phone (708) 577-5003
5424 159th St
#32
Oak Forest, IL 60452
Phone (708) 577-5003
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor |
111N00000X | Yes |
Addresses
Primary practice location
5424 159TH St
#32
Oak Forest, IL 60452-3248
Mailing address
2625 Butterfield Rd
Ste 301N
Oak Brook, IL 60523-1234
Phone (630) 468-1824
Other providers in Oak Forest, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 24, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.