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General NPI Number Information
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NPI Number | 1215262845
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Entity Type | Organization
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Legal Business Name | HEALTH SOURCE OF WICKER PARK PC
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Dates
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Enumeration Date | 10/15/2009
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Last Update Date | 01/30/2024
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Provider Practice Location Address
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Address Line | 1448 N. MILWAUKEE AVE. 3RD FL
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City | CHICAGO
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State | IL
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Zip | 60622
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Country | US
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Telephone | 773-772-4000
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Fax | 773-772-4044
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Provider Business Mailing Address
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Address Line | 1448 N. MILWAUKEE AVE. 3RD FL
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City | CHICAGO
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State | IL
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Zip | 60622
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Country | US
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Telephone | 773-772-4000
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Fax | 773-772-4044
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KARI SCHMIDT
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Credential | D.C.
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Telephone | 773-772-4000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 038008228
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License Number State | IL
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