1770248320 NPI number — CHIRO ONE WELLNESS CENTER OF LIBERTY LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770248320 NPI number — CHIRO ONE WELLNESS CENTER OF LIBERTY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHIRO ONE WELLNESS CENTER OF LIBERTY LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1770248320
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/20/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 74008519 CHIRO ONE1651
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60674-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-320-6400
Provider Business Mailing Address Fax Number:
630-468-1478

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9040 NE BARRY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64157-1246
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-368-8700
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/08/2021

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BERNSEN
Authorized Official First Name:
STUART
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
630-320-6400

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)