Healthcare Provider Details

I. General information

NPI: 1174390678
Provider Name (Legal Business Name): JACQUELINE HILBRICH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2023
Last Update Date: 12/05/2023
Certification Date: 12/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1022 W ARMITAGE AVE STE B
CHICAGO IL
60614-4102
US

IV. Provider business mailing address

3614 CREEKSIDE DR
VALPARAISO IN
46383-0960
US

V. Phone/Fax

Practice location:
  • Phone: 773-234-1042
  • Fax:
Mailing address:
  • Phone: 219-476-5263
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number198001635
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: