Healthcare Provider Details

I. General information

NPI: 1831792886
Provider Name (Legal Business Name): ECCENTRIC LEARNING LABORATORIES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2020
Last Update Date: 05/09/2025
Certification Date: 05/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4765 N LINCOLN AVE STE 209
CHICAGO IL
60625-2077
US

IV. Provider business mailing address

4765 N LINCOLN AVE STE 209
CHICAGO IL
60625-2077
US

V. Phone/Fax

Practice location:
  • Phone: 714-719-6740
  • Fax:
Mailing address:
  • Phone: 714-719-6740
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. PETER PLATTEN
Title or Position: OWNER
Credential: PHD
Phone: 608-213-9284