Healthcare Provider Details

I. General information

NPI: 1033289475
Provider Name (Legal Business Name): EVANGELIA SKOKOS D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 E ROOSEVELT RD
LOMBARD IL
60148-4539
US

IV. Provider business mailing address

721 W LAKE ST STE 201
ADDISON IL
60101-2035
US

V. Phone/Fax

Practice location:
  • Phone: 630-889-6459
  • Fax:
Mailing address:
  • Phone: 630-290-3380
  • Fax: 630-385-0141

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038-009812
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: