The Wellness Source of Roscoe Village

Primary specialty

ChiropractorTaxonomy code 111N00000X

Legal business name

THE WELLNESS SOURCE OF ROSCOE VILLAGE

Practice address

1902 W Belmont Ave
Chicago, IL 60657-9474

Phone

(224) 567-8580

NPI assigned

May 11, 2012

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

Title

Managing Member

Phone

(224) 567-8580

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Matthew Anthony Ray, D.C.

  • Chiropractor
  • Chicago, IL
  • NPI 1730424797
  NPD (past)

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

{
    "created_epoch": "1336694400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1336694400000",
    "number": "1215296124",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1902 W BELMONT AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606579474"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1902 W BELMONT AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606579474",
            "telephone_number": "224-567-8580"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE WELLNESS SOURCE OF ROSCOE VILLAGE",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-05-11",
        "last_updated": "2012-05-11",
        "status": "A",
        "authorized_official_last_name": "LOPEZ",
        "authorized_official_first_name": "DENNIS",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "224-567-8580"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "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 May 11, 2012; 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.