Healthcare Provider Details

I. General information

NPI: 1851008536
Provider Name (Legal Business Name): ULF HENRICSSON SPORTS AND HEALTH CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2022
Last Update Date: 11/01/2022
Certification Date: 11/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 W GRAND AVE STE 402
CHICAGO IL
60654-7129
US

IV. Provider business mailing address

101 W GRAND AVE STE 402
CHICAGO IL
60654-7129
US

V. Phone/Fax

Practice location:
  • Phone: 312-661-0660
  • Fax: 708-991-9003
Mailing address:
  • Phone: 312-661-0660
  • Fax: 708-991-9003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172P00000X
TaxonomyNaprapath
License Number
License Number State

VIII. Authorized Official

Name: DR. ULF RIKARD HENRICSSON
Title or Position: OWNER
Credential: DOCTOR OF NAPRAPATHY
Phone: 312-661-0660