Provider Demographics
NPI:1770248320
Name:CHIRO ONE WELLNESS CENTER OF LIBERTY LLC
Entity type:Organization
Organization Name:CHIRO ONE WELLNESS CENTER OF LIBERTY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:STUART
Authorized Official - Middle Name:
Authorized Official - Last Name:BERNSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-320-6400
Mailing Address - Street 1:PO BOX 74008519 CHIRO ONE1651
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60674-0001
Mailing Address - Country:US
Mailing Address - Phone:630-320-6400
Mailing Address - Fax:630-468-1478
Practice Address - Street 1:9040 NE BARRY RD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64157-1246
Practice Address - Country:US
Practice Address - Phone:816-368-8700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-08
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty