Chicago Sport and Wellness

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

038012256 Issued in IL

Legal business name

CHICAGO SPORT AND WELLNESS

Practice address

1200 Old Skokie Valley Rd
Highland Park, IL 60035-3036

Phone

(773) 852-8423

NPI assigned

Jun 16, 2014

Organization subpart

No

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

Authorized official

Name

Dr. Sunil Simon Pullukat, D.C

Title

Chiropractor/ Ceo

Phone

(773) 852-8423

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1402876800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1402876800000",
    "number": "1184038366",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5306 N RUTHERFORD AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606562131",
            "telephone_number": "773-852-8423"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 OLD SKOKIE VALLEY RD",
            "city": "HIGHLAND PARK",
            "state": "IL",
            "postal_code": "600353036",
            "telephone_number": "773-852-8423"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHICAGO SPORT AND WELLNESS",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-06-16",
        "last_updated": "2014-06-16",
        "status": "A",
        "authorized_official_last_name": "PULLUKAT",
        "authorized_official_first_name": "SUNIL",
        "authorized_official_middle_name": "SIMON",
        "authorized_official_title_or_position": "CHIROPRACTOR/ CEO",
        "authorized_official_telephone_number": "773-852-8423",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "IL",
            "license": "038012256",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Chiropractor in Highland Park, IL
• Providers in Highland Park, IL by specialty
• Chiropractor in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2014; 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.