Healthcare Provider Details

I. General information

NPI: 1528133790
Provider Name (Legal Business Name): STUART EVAN YOSS D.C., CCSP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/22/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 WAUKEGAN RD SUITE 100
BANNOCKBURN IL
60015-1836
US

IV. Provider business mailing address

229 FOX RUN DR
NORTHBROOK IL
60062-1511
US

V. Phone/Fax

Practice location:
  • Phone: 847-236-1194
  • Fax: 847-236-1195
Mailing address:
  • Phone: 847-498-1401
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number038-007835
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: