Healthcare Provider Details

I. General information

NPI: 1326443730
Provider Name (Legal Business Name): CLARETHA A. YEAGER DACM, L.AC., MSTOM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2014
Last Update Date: 05/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

134 N LA SALLE ST STE 2140
CHICAGO IL
60602
US

IV. Provider business mailing address

134 N LA SALLE ST STE 2140
CHICAGO IL
60602-1126
US

V. Phone/Fax

Practice location:
  • Phone: 773-669-5724
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number198.001120
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: