Healthcare Provider Details

I. General information

NPI: 1205134749
Provider Name (Legal Business Name): HEIDI BEUCHER L.AC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

203 N WABASH AVE SUITE 1007
CHICAGO IL
60601-2406
US

IV. Provider business mailing address

203 N WABASH AVE SUITE 1007
CHICAGO IL
60601-2406
US

V. Phone/Fax

Practice location:
  • Phone: 708-220-1979
  • Fax:
Mailing address:
  • Phone: 708-220-1979
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number198.000963
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: