Provider Demographics
NPI:1447021654
Name:NEXGEN WELLNESS & SPORTS MEDICINE
Entity type:Organization
Organization Name:NEXGEN WELLNESS & SPORTS MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:MURILLO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:925-408-2909
Mailing Address - Street 1:840 MICHIGAN AVE APT 5
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60202-2588
Mailing Address - Country:US
Mailing Address - Phone:224-222-1799
Mailing Address - Fax:224-714-0628
Practice Address - Street 1:3200 W HIGGINS RD STE 101
Practice Address - Street 2:
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60169-2174
Practice Address - Country:US
Practice Address - Phone:925-408-2909
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-16
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty