Organization
APPLIED WELLNESS CENTER SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JANELLE PATTARA (BILLER)
(630) 890-2758
Entity
Organization
Contact information
Practice address
13301 S RIDGELAND AVE, STE A, PALOS HEIGHTS, IL 60463-0030
(708) 489-3700
(708) 489-3705
Mailing address
13301 S RIDGELAND AVE, STE A, PALOS HEIGHTS, IL 60463-0030
(708) 489-3700
(708) 489-3705
Taxonomy
Speciality
Code
Description
License number
State
111NN1001X
Nutrition Chiropractor
Primary
038.008810
IL
111NN1001X
Nutrition Chiropractor
038008810
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
09927458
BCBS
IL
01
—
210819
MC PROVIDER #
IL
Enumeration date
12/04/2006
Last updated
08/15/2011
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