Provider Demographics
NPI:1962956482
Name:SOS CHIROPRACTIC INC.
Entity type:Organization
Organization Name:SOS CHIROPRACTIC INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:
Authorized Official - Last Name:GARAVITO
Authorized Official - Suffix:
Authorized Official - Credentials:DC, PTA
Authorized Official - Phone:708-231-0012
Mailing Address - Street 1:2223 OAK PARK AVE
Mailing Address - Street 2:GARDEN SUITE
Mailing Address - City:BERWYN
Mailing Address - State:IL
Mailing Address - Zip Code:60402-4670
Mailing Address - Country:US
Mailing Address - Phone:708-231-0012
Mailing Address - Fax:
Practice Address - Street 1:2223 OAK PARK AVE
Practice Address - Street 2:
Practice Address - City:BERWYN
Practice Address - State:IL
Practice Address - Zip Code:60402-4670
Practice Address - Country:US
Practice Address - Phone:708-231-0012
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-12
Last Update Date:2016-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty