Healthcare Provider Details

I. General information

NPI: 1083011845
Provider Name (Legal Business Name): WELL WITH MY SOUL HOLISTIC HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2014
Last Update Date: 09/03/2024
Certification Date: 09/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 S DORCHESTER AVE # 100
CHICAGO IL
60628-1700
US

IV. Provider business mailing address

8149 S BLACKSTONE AVE
CHICAGO IL
60619-4616
US

V. Phone/Fax

Practice location:
  • Phone: 773-978-6145
  • Fax: 773-913-1792
Mailing address:
  • Phone: 773-978-6145
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2081N0008X
TaxonomyNeuromuscular Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code172P00000X
TaxonomyNaprapath
License Number
License Number State

VIII. Authorized Official

Name: DR. SOONITI JEANETTE WEEMS
Title or Position: OWNER
Credential: DN, LCSW, LMT
Phone: 773-978-6145