Provider Demographics
NPI:1902586753
Name:WILL COUNTY WELLNESS CENTER
Entity Type:Organization
Organization Name:WILL COUNTY WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:KRAVARIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-666-4680
Mailing Address - Street 1:2450 GLENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-5463
Mailing Address - Country:US
Mailing Address - Phone:157-140-0088
Mailing Address - Fax:
Practice Address - Street 1:2450 GLENWOOD AVE
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-5463
Practice Address - Country:US
Practice Address - Phone:157-140-0088
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-18
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty