Healthcare Provider Details

I. General information

NPI: 1982139101
Provider Name (Legal Business Name): HERB AND OHM, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2017
Last Update Date: 04/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 W RANDOLPH ST STE 1800
CHICAGO IL
60606-1820
US

IV. Provider business mailing address

936 W MADISON ST APT 3E
CHICAGO IL
60607-2621
US

V. Phone/Fax

Practice location:
  • Phone: 312-757-1882
  • Fax:
Mailing address:
  • Phone: 312-757-1882
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number248.001134
License Number StateIL

VIII. Authorized Official

Name: AMY WOLF
Title or Position: OWNER
Credential: DACM, L.AC.
Phone: 312-757-1882