Crystal Lake Family Wellness

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

038012416 Issued in IL

Legal business name

CRYSTAL LAKE FAMILY WELLNESS

Practice address

4777 Northwest Hwy
Unit C
Crystal Lake, IL 60014-7340

Phone

(815) 788-7504

Fax

(815) 788-7508

NPI assigned

Mar 27, 2014

Last updated

Mar 27, 2014By 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

Dr. Joshua Christopher Young, D.C.

Title

Director

Phone

(484) 354-4289

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Locations

Practitioners 1

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.

• Josh Young, D.C.

  • Chiropractor
  • Twin Lakes, WI
  • NPI 1861814147

  IL

  Medicare reassignment NPD

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

{
    "created_epoch": "1395878400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1395878400000",
    "number": "1710304787",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4777 NORTHWEST HWY",
            "address_2": "UNIT C",
            "city": "CRYSTAL LAKE",
            "state": "IL",
            "postal_code": "600147340",
            "telephone_number": "815-788-7504",
            "fax_number": "815-788-7508"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4777 NORTHWEST HWY",
            "address_2": "UNIT C",
            "city": "CRYSTAL LAKE",
            "state": "IL",
            "postal_code": "600147340",
            "telephone_number": "815-788-7504",
            "fax_number": "815-788-7508"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CRYSTAL LAKE FAMILY WELLNESS",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-03-27",
        "last_updated": "2014-03-27",
        "status": "A",
        "authorized_official_last_name": "YOUNG",
        "authorized_official_first_name": "JOSHUA",
        "authorized_official_middle_name": "CHRISTOPHER",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "484-354-4289",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "IL",
            "license": "038012416",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Crystal Lake CC SCH Dist 47
• Crystal Lake Center for Chronic Pain SC
• Crystal Lake Dermatology SC
• Crystal Lake Family Dental
• Crystal Lake Family Treatment Center LTD
• Crystal Lake Foot & Ankle Center LLC
• Crystal Lake Immediate Care Physicians LTD.
• Crystal Lake Medical and Sports Rehab SC
• Crystal Lake Memory Care, LLC (Autumn Leaves of Crystal Lake)
• Crystal Lake Natural Health Care

• Chiropractor in Crystal Lake, IL
• Providers in Crystal Lake, IL by specialty
• Chiropractor in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2014; 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.