# CALLISTA C LAY LTD

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Genesis Chiropractic Wellness Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1952657991
- **Authorized official:** DR. CALLISTA C LAY DC (PRESIDENT)
- **Authorized official phone:** (312) 491-8100

## Contact information

- **Practice address:** 1169 W MADISON, CHICAGO, IL 60607
- **Practice address phone:** (312) 491-8100
- **Practice address fax:** (312) 491-8105
- **Mailing address:** 917 W WASHINGTON BLVD BOX 254, CHICAGO, IL 60607
- **Mailing address phone:** (312) 491-8100
- **Mailing address fax:** (312) 491-8105

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 111N00000X | Chiropractor | 038012202 | IL | Yes |

## Other

- **Enumeration date:** 07/27/2012
- **Last updated:** 11/21/2016