Organization
AXIAL SPINE & WELLNESS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TODD PETERSON D.C. (OWNER)
(312) 523-4392
Entity
Organization
Contact information
Practice address
954 W WASHINGTON BLVD, SUITE 110, CHICAGO, IL 60607-2224
(308) 227-9071
Mailing address
954 W WASHINGTON BLVD STE 610, CHICAGO, IL 60607-2293
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
038012711
IL
Other
Enumeration date
08/18/2016
Last updated
09/28/2020
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