Healthcare Provider Details

I. General information

NPI: 1477369296
Provider Name (Legal Business Name): CHICAGO HOLISTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2024
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4223 N LINCOLN AVE
CHICAGO IL
60618-2901
US

IV. Provider business mailing address

3522 N BOSWORTH AVE
CHICAGO IL
60657-1365
US

V. Phone/Fax

Practice location:
  • Phone: 312-478-8779
  • Fax:
Mailing address:
  • Phone: 312-478-8779
  • 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: CHRISTOPHER AVILA
Title or Position: OWNER
Credential:
Phone: 312-478-8779