The Wellness Source of Teddie Kossof, Inc

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

038010594 Issued in IL

Legal business name

THE WELLNESS SOURCE OF TEDDIE KOSSOF, INC

Practice address

3324 N Halsted St
Chicago, IL 60657-2413

Phone

(312) 848-5668

NPI assigned

Mar 24, 2014

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dennis J Lopez, DC

Title

Owner

Phone

(312) 848-5668

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1395619200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1453852800000",
    "number": "1063839488",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3324 N HALSTED ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606572413",
            "telephone_number": "773-906-9265"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3324 N HALSTED ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606572413",
            "telephone_number": "312-848-5668"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE WELLNESS SOURCE OF TEDDIE KOSSOF, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-03-24",
        "last_updated": "2016-01-27",
        "status": "A",
        "authorized_official_last_name": "LOPEZ",
        "authorized_official_first_name": "DENNIS",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "312-848-5668",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "IL",
            "license": "038010594",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Chiropractor in Chicago, IL
• Providers in Chicago, IL by specialty
• Chiropractor in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.