Healthcare Provider Details

I. General information

NPI: 1366778730
Provider Name (Legal Business Name): ACUBALANCE WELLNESS CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2009
Last Update Date: 10/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6015 N NINA AVE
CHICAGO IL
60631-2411
US

IV. Provider business mailing address

6015 N NINA AVE
CHICAGO IL
60631-2411
US

V. Phone/Fax

Practice location:
  • Phone: 773-775-4257
  • Fax: 773-775-4845
Mailing address:
  • Phone: 773-775-4257
  • Fax: 773-775-4845

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code173C00000X
TaxonomyReflexologist
License NumberNA
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number198-000837
License Number StateIL

VIII. Authorized Official

Name: MS. JULIANN M DOMAGALSKI
Title or Position: CO-OWNER
Credential: L.AC.
Phone: 773-775-4257