# CROCKETT WELLNESS CLINIC LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1487300935
- **Authorized official:** ANDRE D CROCKETT ND (MANAGING DIRECTOR)
- **Authorized official phone:** (331) 888-6505

## Contact information

- **Practice address:** 2829 STONEWATER DR, NAPERVILLE, IL 60564
- **Practice address phone:** (630) 454-1143
- **Mailing address:** 3075 BOOK RD UNIT 9155, NAPERVILLE, IL 60567-1422
- **Mailing address phone:** (630) 454-1143

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261Q00000X | Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 02/23/2022
- **Last updated:** 02/23/2022