Provider Demographics
NPI:1033289475
Name:SKOKOS, EVANGELIA (DC)
Entity Type:Individual
Prefix:DR
First Name:EVANGELIA
Middle Name:
Last Name:SKOKOS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:721 W LAKE ST STE 201
Mailing Address - Street 2:
Mailing Address - City:ADDISON
Mailing Address - State:IL
Mailing Address - Zip Code:60101-2035
Mailing Address - Country:US
Mailing Address - Phone:630-290-3380
Mailing Address - Fax:630-385-0141
Practice Address - Street 1:200 E ROOSEVELT RD
Practice Address - Street 2:
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-4539
Practice Address - Country:US
Practice Address - Phone:630-889-6459
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-009812111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK14527Medicare ID - Type UnspecifiedCHIROPRACTOR