Healthcare Provider Details

I. General information

NPI: 1477385425
Provider Name (Legal Business Name): TOTAL BODY CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2024
Last Update Date: 05/22/2025
Certification Date: 05/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

840 W IRVING PARK RD STE 204
CHICAGO IL
60613-3011
US

IV. Provider business mailing address

840 W IRVING PARK RD STE 204
CHICAGO IL
60613-3011
US

V. Phone/Fax

Practice location:
  • Phone: 773-370-8679
  • Fax:
Mailing address:
  • Phone: 773-370-8679
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code261QR1100X
TaxonomyResearch Clinic/Center
License Number
License Number StateNULL
# 4
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code163WI0500X
TaxonomyInfusion Therapy Registered Nurse
License Number
License Number StateNULL

VIII. Authorized Official

Name: RITA ELUE
Title or Position: NURSE PRACTITIONER
Credential: DNP, FNP-BC, MPH
Phone: 773-370-8679