Provider Demographics
NPI:1285047936
Name:WELLNESS GROUP LLC
Entity type:Organization
Organization Name:WELLNESS GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:WADE
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITTIER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:847-818-0309
Mailing Address - Street 1:15 S DRYDEN PL
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60004-6369
Mailing Address - Country:US
Mailing Address - Phone:847-818-0309
Mailing Address - Fax:847-818-0310
Practice Address - Street 1:15 S DRYDEN PL
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60004-6369
Practice Address - Country:US
Practice Address - Phone:847-818-0309
Practice Address - Fax:847-818-0310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-10
Last Update Date:2014-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038006080111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty