John Louis Disselhorst

Primary specialty

Social WorkerTaxonomy code 104100000X

License

150.117126 Issued in IL

Practice address

4711 N Broadway St Ste 105
Chicago, IL 60640-4908

Phone

(815) 382-2981

NPI assigned

Aug 8, 2024

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Jack Disselhorst Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1723075200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1765411200000",
    "number": "1093546442",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4711 N BROADWAY ST STE 105",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606404908",
            "telephone_number": "815-382-2981"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4711 N BROADWAY ST STE 105",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606404908",
            "telephone_number": "815-382-2981"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DISSELHORST",
        "first_name": "JOHN",
        "middle_name": "LOUIS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-08-08",
        "last_updated": "2025-12-11",
        "certification_date": "2025-12-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "IL",
            "license": "150.117126",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JACK",
            "last_name": "DISSELHORST",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Nina Monet Dismukes
• Marco Antonio Dispagna, MD
• Dispatchhealth-Arizona
• Karl F Disque, D.O. RPH
• Vinodinee Lanka Dissanayake, M.D.
• Moshe Dissen
• Justine Distel, OTD; OTR/L
• Adijatu Disu
• Talia Ruth Ditkoff
• Lorelei Elizabeth Ditommaso, M.D., M.P.H.

• Social Worker in Chicago, IL
• Providers in Chicago, IL by specialty
• Social Worker in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2025; 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.