Healthcare Provider Details

I. General information

NPI: 1659235877
Provider Name (Legal Business Name): AVONDALE ACUPUNCTURE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2025
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3958 N AVONDALE AVE
CHICAGO IL
60641-6245
US

IV. Provider business mailing address

3958 N AVONDALE AVE
CHICAGO IL
60641-6245
US

V. Phone/Fax

Practice location:
  • Phone: 240-603-8791
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: CHRISTIAN VILLACRES
Title or Position: DOCTOR OF ACUPUNCTURE
Credential: DAOM
Phone: 240-603-8791