NPIMap

Organization Active NPI

Gold Coast Wellness Center LTD.

Doing business as Gold Coast Wellness

  • Chiropractor
  • Chicago, IL
National Provider Identifier
1073607016
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
Legal business name
GOLD COAST WELLNESS CENTER LTD.
Doing business as
Gold Coast Wellness
Practice address
1360 N Sandburg Ter
Suite 101
Chicago, IL 60610-2075
Phone
(312) 944-4653
Fax
(312) 944-0747
NPI assigned
Oct 3, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Sargon Benjamin Odisho, D.C.NPI 1790714061
Title
Owner
Phone
(312) 944-4653

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193200000X MULTI-SPECIALTY GROUP 111N00000X IL Primary

Addresses

Primary practice location

1360 N Sandburg Ter
Suite 101
Chicago, IL 60610-2075

Mailing address

1360 N Sandburg Ter
Suite 101
Chicago, IL 60610-2075
Phone (312) 944-4653

Other names 1

  • Gold Coast Wellness Doing business as

National Provider Directory

National Provider Directory

Locations

1360 N Sandburg Ter
Ste 101
Chicago, IL 60610
Phone (312) 944-4653

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1159833600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1073607016",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1360 N SANDBURG TER",
            "address_2": "SUITE 101",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606102075",
            "telephone_number": "312-944-4653",
            "fax_number": "312-944-0747"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1360 N SANDBURG TER",
            "address_2": "SUITE 101",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606102075",
            "telephone_number": "312-944-4653",
            "fax_number": "312-944-0747"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GOLD COAST WELLNESS CENTER LTD.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-03",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "ODISHO",
        "authorized_official_first_name": "SARGON",
        "authorized_official_middle_name": "BENJAMIN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "312-944-4653",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Gold Coast Wellness",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Chicago, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.