Provider Demographics
NPI:1083011845
Name:WELL WITH MY SOUL HOLISTIC HEALTH CENTER
Entity Type:Organization
Organization Name:WELL WITH MY SOUL HOLISTIC HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SOONITI
Authorized Official - Middle Name:JEANETTE
Authorized Official - Last Name:WEEMS
Authorized Official - Suffix:
Authorized Official - Credentials:DN
Authorized Official - Phone:773-978-6145
Mailing Address - Street 1:8149 S BLACKSTONE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60619-4616
Mailing Address - Country:US
Mailing Address - Phone:773-978-6145
Mailing Address - Fax:
Practice Address - Street 1:8149 S BLACKSTONE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60619-4616
Practice Address - Country:US
Practice Address - Phone:773-978-6145
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-21
Last Update Date:2016-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL181.000396111NN1001X, 111NR0400X
181.000396172P00000X
IL225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172P00000XOther Service ProvidersNaprapathGroup - Single Specialty
No111NN1001XChiropractic ProvidersChiropractorNutritionGroup - Single Specialty
No111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty