Provider Demographics
NPI:1053695031
Name:MIDWEST WELLNESS HEALTH CENTER, LTD
Entity type:Organization
Organization Name:MIDWEST WELLNESS HEALTH CENTER, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:A
Authorized Official - Last Name:MASUKAWA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:847-530-7310
Mailing Address - Street 1:629 DAVID ST
Mailing Address - Street 2:
Mailing Address - City:LAKE IN THE HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60156-5204
Mailing Address - Country:US
Mailing Address - Phone:847-530-7310
Mailing Address - Fax:847-660-6310
Practice Address - Street 1:3202 NORTHWEST HWY
Practice Address - Street 2:SUITE E
Practice Address - City:CARY
Practice Address - State:IL
Practice Address - Zip Code:60013-3507
Practice Address - Country:US
Practice Address - Phone:847-530-7310
Practice Address - Fax:847-660-6310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-07
Last Update Date:2011-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-007971111N00000X
IL036-105621208D00000X
IL042-619859208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty