Provider Demographics
NPI:1528788262
Name:BE WELL CHIRO PLLC
Entity type:Organization
Organization Name:BE WELL CHIRO PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SAGE
Authorized Official - Middle Name:M
Authorized Official - Last Name:STORJOHANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:309-786-0883
Mailing Address - Street 1:4110 BLACKHAWK RD STE 1
Mailing Address - Street 2:
Mailing Address - City:ROCK ISLAND
Mailing Address - State:IL
Mailing Address - Zip Code:61201-7039
Mailing Address - Country:US
Mailing Address - Phone:309-786-0883
Mailing Address - Fax:
Practice Address - Street 1:4110 BLACKHAWK RD STE 1
Practice Address - Street 2:
Practice Address - City:ROCK ISLAND
Practice Address - State:IL
Practice Address - Zip Code:61201-7039
Practice Address - Country:US
Practice Address - Phone:309-786-0883
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-01
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty