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Organization
THE WELLNESS SOURCE OF ROSCOE VILLAGE
Active
Organization
THE WELLNESS SOURCE OF ROSCOE VILLAGE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DENNIS J LOPEZ (MANAGING MEMBER)
(224) 567-8580
Entity
Organization
Contact information
Practice address
1902 W BELMONT AVE, CHICAGO, IL 60657-9474
(224) 567-8580
Mailing address
1902 W BELMONT AVE, CHICAGO, IL 60657-9474
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
—
—
Other
Enumeration date
05/11/2012
Last updated
05/11/2012
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