Provider Demographics
NPI:1285418095
Name:GRATEFUL HEALTH AND WELLNESS CENTER, PLLC
Entity type:Organization
Organization Name:GRATEFUL HEALTH AND WELLNESS CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:OWENS
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:312-692-1867
Mailing Address - Street 1:6033 N SHERIDAN RD APT 18D
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60660-3030
Mailing Address - Country:US
Mailing Address - Phone:312-692-1867
Mailing Address - Fax:
Practice Address - Street 1:747 N. LASALLE
Practice Address - Street 2:SUITE 600E
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60654-5089
Practice Address - Country:US
Practice Address - Phone:312-692-1867
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GRATEFUL HEALTH AND WELLNESS CENTER, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-08-22
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty