# GOLD COAST OSTEOPATHIC, PSC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1568816254
- **Authorized official:** DR. AIDA BECKERLY (PRESIDENT)
- **Authorized official phone:** (773) 553-6055

## Contact information

- **Practice address:** 680 N LAKE SHORE DR, SUITE 1040, CHICAGO, IL 60611-4546
- **Practice address phone:** (773) 554-6055
- **Mailing address:** 680 N LAKE SHORE DR STE 1040, CHICAGO, IL 60611-8718

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 204D00000X | Neuromusculoskeletal Medicine & OMM Physician | 02004367B | IN | — |
| 204D00000X | Neuromusculoskeletal Medicine & OMM Physician | 243290 | MA | — |
| 204D00000X | Neuromusculoskeletal Medicine & OMM Physician | 261752 | NY | — |
| 204D00000X | Neuromusculoskeletal Medicine & OMM Physician | — | IL | — |
| 207Q00000X | Family Medicine Physician | 02004367A | IN | — |
| 207Q00000X | Family Medicine Physician | 243290 | MA | — |
| 207Q00000X | Family Medicine Physician | 261752 | NY | — |
| 207Q00000X | Family Medicine Physician | — | IL | Yes |

## Other

- **Enumeration date:** 04/19/2016
- **Last updated:** 04/19/2016