Gold Coast Wellness Center LTD.

Primary specialty

ChiropractorTaxonomy code 111N00000X

Legal business name

GOLD COAST WELLNESS CENTER LTD.

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

Organization subpart

No

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.

Title

Owner

Phone

(312) 944-4653

Specialties & licenses 1

Addresses

Other names 1

• Gold Coast Wellness Doing business as

Locations

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"
        }
    ]
}

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• Rebecca L Gold-Stein, PSY.D.
• Alexandra Gold

• 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 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.