Healthcare Provider Details

I. General information

NPI: 1376252692
Provider Name (Legal Business Name): INNER G RESTORATIVE & HOLISTIC CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2022
Last Update Date: 03/23/2025
Certification Date: 03/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1626 W MONTROSE AVE UNIT B
CHICAGO IL
60613-1214
US

IV. Provider business mailing address

1626 W MONTROSE AVE UNIT B
CHICAGO IL
60613-1214
US

V. Phone/Fax

Practice location:
  • Phone: 312-313-8843
  • Fax: 872-666-0790
Mailing address:
  • Phone: 312-687-0224
  • Fax: 872-666-0790

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. GRISELLE QUINONES
Title or Position: OWNER, LEAD MASSAGE THERAPIST
Credential: LMT
Phone: 847-865-6113