Healthcare Provider Details

I. General information

NPI: 1487722666
Provider Name (Legal Business Name): WHOLEHEALTH CHICAGO-3
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 07/15/2021
Certification Date: 07/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2522 N LINCOLN AVE
CHICAGO IL
60614-2352
US

IV. Provider business mailing address

2565 N CLYBOURN AVE
CHICAGO IL
60614-3052
US

V. Phone/Fax

Practice location:
  • Phone: 773-296-6700
  • Fax: 773-296-1131
Mailing address:
  • Phone: 773-296-6700
  • Fax: 773-296-1131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DAVID KEITH EDELBERG
Title or Position: SECRETARY
Credential: MD
Phone: 773-296-6700