Healthcare Provider Details

I. General information

NPI: 1740103027
Provider Name (Legal Business Name): CHRISTINA BELEN DUNGCA DACCHM, LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 W MADISON ST STE 2
CHICAGO IL
60607-2055
US

IV. Provider business mailing address

6230 N WASHTENAW AVE
CHICAGO IL
60659-2675
US

V. Phone/Fax

Practice location:
  • Phone: 312-414-0058
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number198011994
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: