Provider Demographics
NPI:1861894081
Name:ONE GOAL WELLNESS, INC
Entity type:Organization
Organization Name:ONE GOAL WELLNESS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIANA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:TORRES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:847-265-5600
Mailing Address - Street 1:36735 N. IL 83
Mailing Address - Street 2:STE D
Mailing Address - City:LAKE VILLA
Mailing Address - State:IL
Mailing Address - Zip Code:60046
Mailing Address - Country:US
Mailing Address - Phone:847-265-5600
Mailing Address - Fax:847-245-4491
Practice Address - Street 1:36735 N. IL 83
Practice Address - Street 2:STE D
Practice Address - City:LAKE VILLA
Practice Address - State:IL
Practice Address - Zip Code:60046
Practice Address - Country:US
Practice Address - Phone:847-265-5600
Practice Address - Fax:847-245-4491
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-18
Last Update Date:2024-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.012071111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL6324Medicare PIN