Premier Wellness Chiropracitc, Inc.

Primary specialty

ChiropractorTaxonomy code 111N00000X

Legal business name

PREMIER WELLNESS CHIROPRACITC, INC.

Practice address

411 E Congress Pkwy
Suite C
Crystal Lake, IL 60014-6247

Phone

(815) 455-8213

Fax

(815) 455-8219

NPI assigned

Nov 20, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Anthony J Ebel, D.C.

Title

President

Phone

(815) 455-8213

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1195516800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1195516800000",
    "number": "1881875755",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "411 E CONGRESS PKWY",
            "address_2": "SUITE C",
            "city": "CRYSTAL LAKE",
            "state": "IL",
            "postal_code": "600146247",
            "telephone_number": "815-455-8213",
            "fax_number": "815-455-8219"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "411 E CONGRESS PKWY",
            "address_2": "SUITE C",
            "city": "CRYSTAL LAKE",
            "state": "IL",
            "postal_code": "600146247",
            "telephone_number": "815-455-8213",
            "fax_number": "815-455-8219"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER WELLNESS CHIROPRACITC, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-20",
        "last_updated": "2007-11-20",
        "status": "A",
        "authorized_official_last_name": "EBEL",
        "authorized_official_first_name": "ANTHONY",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "815-455-8213",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• 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 Nov 20, 2007; 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.