Healthcare Provider Details

I. General information

NPI: 1477479699
Provider Name (Legal Business Name): UPSTREAM MEDICINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1802 W BERTEAU AVE STE 202
CHICAGO IL
60613-6182
US

IV. Provider business mailing address

1850 N MOZART ST UNIT 2
CHICAGO IL
60647-5112
US

V. Phone/Fax

Practice location:
  • Phone: 858-775-1985
  • Fax:
Mailing address:
  • Phone: 858-775-1985
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: WILLIAM PATRICK RILEY
Title or Position: ACUPUNCTURIST
Credential: LAC, MSTOM, DIPL. OM
Phone: 858-775-1985