Provider Demographics
NPI:1992576359
Name:LONGEVITY STRENGTH AND WELLNESS CENTER LLC
Entity type:Organization
Organization Name:LONGEVITY STRENGTH AND WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:COLTON
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:847-721-4977
Mailing Address - Street 1:4N525 HUNTER CT
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60175-7920
Mailing Address - Country:US
Mailing Address - Phone:847-721-4966
Mailing Address - Fax:
Practice Address - Street 1:4N525 HUNTER CT
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60175-7920
Practice Address - Country:US
Practice Address - Phone:847-721-4966
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-12
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty