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General NPI Number Information
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NPI Number | 1982294856
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Entity Type | Organization
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Legal Business Name | NORTHSIDE WELLNESS CENTER LTD
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Dates
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Enumeration Date | 01/24/2021
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Last Update Date | 01/24/2021
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Provider Practice Location Address
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Address Line | 7001 W HIGGINS AVE # 2A
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City | CHICAGO
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State | IL
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Zip | 60656-1949
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Country | US
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Telephone | 773-852-1236
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Fax |
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Provider Business Mailing Address
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Address Line | 4581 N MERRIMAC AVE
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City | CHICAGO
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State | IL
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Zip | 60630-3017
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Country | US
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Telephone | 773-852-1236
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Fax |
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Authorized Official
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Title or Position | DOCTOR
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Name | SAMANTHA SZYSKA
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Credential | DC
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Telephone | 773-852-1236
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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 |
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License Number State |
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