Healthcare Provider Details

I. General information

NPI: 1508165614
Provider Name (Legal Business Name): CHICAGO HEALTH PARTNERS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2011
Last Update Date: 04/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

356 W SUPERIOR ST
CHICAGO IL
60654-3416
US

IV. Provider business mailing address

356 W SUPERIOR ST
CHICAGO IL
60654-3416
US

V. Phone/Fax

Practice location:
  • Phone: 773-746-9933
  • Fax:
Mailing address:
  • Phone: 773-746-9933
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038004928
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberDA00369
License Number StateRI
# 3
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number198000961
License Number StateIL

VIII. Authorized Official

Name: DR. MISHA JOSEF PAYANT
Title or Position: DR. / OWNER
Credential: D.AC.
Phone: 773-746-9933