Axial Spine & Wellness, LLC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

038012711 Issued in IL

Legal business name

AXIAL SPINE & WELLNESS, LLC

Practice address

954 W Washington Blvd
Suite 110
Chicago, IL 60607-2224

Phone

(308) 227-9071

NPI assigned

Aug 18, 2016

Organization subpart

No

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

Authorized official

Name

Todd Peterson, D.C.

Title

Owner

Phone

(312) 523-4392

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1471478400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1601251200000",
    "number": "1932654084",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "954 W WASHINGTON BLVD STE 610",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606072293"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "954 W WASHINGTON BLVD",
            "address_2": "SUITE 110",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606072224",
            "telephone_number": "308-227-9071"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AXIAL SPINE & WELLNESS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-08-18",
        "last_updated": "2020-09-28",
        "certification_date": "2020-09-28",
        "status": "A",
        "authorized_official_last_name": "PETERSON",
        "authorized_official_first_name": "TODD",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "312-523-4392",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "IL",
            "license": "038012711",
            "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 Sep 28, 2020; 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.