Provider Demographics
NPI:1598456618
Name:HEALTHSOURCE OF DOWNTOWN MOKENA
Entity Type:Organization
Organization Name:HEALTHSOURCE OF DOWNTOWN MOKENA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KARI
Authorized Official - Middle Name:E
Authorized Official - Last Name:SCHMIDT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:219-201-5690
Mailing Address - Street 1:9231 W 138TH ST
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-1376
Mailing Address - Country:US
Mailing Address - Phone:219-201-5690
Mailing Address - Fax:
Practice Address - Street 1:11124 FRONT ST
Practice Address - Street 2:
Practice Address - City:MOKENA
Practice Address - State:IL
Practice Address - Zip Code:60448-1525
Practice Address - Country:US
Practice Address - Phone:219-201-5690
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-18
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty