Healthcare Provider Details

I. General information

NPI: 1093604803
Provider Name (Legal Business Name): IRIS ACUPUNCTURE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2025
Last Update Date: 06/30/2025
Certification Date: 06/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1151 W WASHINGTON BLVD UNIT 103
CHICAGO IL
60607-2002
US

IV. Provider business mailing address

1151 W WASHINGTON BLVD UNIT 103
CHICAGO IL
60607-2002
US

V. Phone/Fax

Practice location:
  • Phone: 414-627-9933
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: TESSA HERMANN
Title or Position: OWNER/ACUPUNCTURIST
Credential:
Phone: 414-627-9933