Healthcare Provider Details

I. General information

NPI: 1013341296
Provider Name (Legal Business Name): INTEGRAL ALTERNATIVE MEDICINE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2013
Last Update Date: 06/23/2021
Certification Date: 06/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 S. DEARBORN ST
CHICAGO IL
60605-1838
US

IV. Provider business mailing address

730 S DEARBORN ST
CHICAGO IL
60605-1838
US

V. Phone/Fax

Practice location:
  • Phone: 312-631-3095
  • Fax:
Mailing address:
  • Phone: 312-631-3095
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name: MARIA CRISTINA TORRES MOORE
Title or Position: CEO
Credential: MSOM, LAC
Phone: 847-337-8057