MEDICARE: WELL WITH MY SOUL HOLISTIC HEALTH CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	1041C0700X	Clinical Social Worker
2	171400000X	Health & Wellness Coach
3	2081N0008X	Neuromuscular Medicine (Physical Medicine & Rehabilitation) Physician
4	225700000X	Massage Therapist
5	172P00000X	Naprapath

General Provider Information

NPI Number	:	1083011845
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WELL WITH MY SOUL HOLISTIC HEALTH CENTER

Provider Business Mailing Address
First Line	:	8149 S BLACKSTONE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60619-4616
Country	:	US
Telephone Number	:	773-978-6145
Fax Number	:

Provider Business Practice Location Address
First Line	:	9500 S DORCHESTER AVE # 100
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60628-1700
Country	:	US
Telephone Number	:	773-978-6145
Fax Number	:	773-913-1792

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

Provider Enumeration Date	:	11/21/2014
Last Update Date	:	09/03/2024

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