Provider Demographics
NPI:1487722716
Name:APPLIED WELLNESS CENTER SC
Entity type:Organization
Organization Name:APPLIED WELLNESS CENTER SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLER
Authorized Official - Prefix:
Authorized Official - First Name:JANELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:PATTARA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-890-2758
Mailing Address - Street 1:13301 S RIDGELAND AVE
Mailing Address - Street 2:STE A
Mailing Address - City:PALOS HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60463-0030
Mailing Address - Country:US
Mailing Address - Phone:708-489-3700
Mailing Address - Fax:708-489-3705
Practice Address - Street 1:13301 S RIDGELAND AVE
Practice Address - Street 2:STE A
Practice Address - City:PALOS HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60463-0030
Practice Address - Country:US
Practice Address - Phone:708-489-3700
Practice Address - Fax:708-489-3705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2011-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038008810111NN1001X
IL038.008810111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN1001XChiropractic ProvidersChiropractorNutritionGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL210819OtherMC PROVIDER #
IL09927458OtherBCBS
IL210819Medicare PIN