MEDICARE: INCLUSIVE WELLNESS, LTD.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	038008001	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1632537	OTHER	IL	BCBS

General Provider Information

NPI Number	:	1417022518
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INCLUSIVE WELLNESS, LTD.

Provider Business Mailing Address
First Line	:	1603 ORRINGTON AVE STE 600
Second Line	:
City	:	EVANSTON
State	:	IL
Zip	:	60201-3860
Country	:	US
Telephone Number	:	312-774-0010
Fax Number	:

Provider Business Practice Location Address
First Line	:	4705 N LINCOLN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60625-2009
Country	:	US
Telephone Number	:	888-978-8287
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	SOHEILA VAHABI
Credential	:	MS, DC, FIAMA
Telephone Number	:	312-774-0010

Provider Enumeration Date	:	11/22/2006
Last Update Date	:	04/21/2020

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Directions to “INCLUSIVE WELLNESS, LTD. ” Practice Location

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