Provider Demographics
NPI:1871915769
Name:JC REJUVENATION AND WELLNESS LTD
Entity type:Organization
Organization Name:JC REJUVENATION AND WELLNESS LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:WITEK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:773-615-4334
Mailing Address - Street 1:825 S ILLINOIS ROUTE 59
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:IL
Mailing Address - Zip Code:60103-1629
Mailing Address - Country:US
Mailing Address - Phone:630-289-1811
Mailing Address - Fax:630-289-1186
Practice Address - Street 1:825 S ILLINOIS ROUTE 59
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:IL
Practice Address - Zip Code:60103-1629
Practice Address - Country:US
Practice Address - Phone:630-289-1181
Practice Address - Fax:630-289-1186
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-10
Last Update Date:2014-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.012557111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty