Healthcare Provider Details

I. General information

NPI: 1407501471
Provider Name (Legal Business Name): ZACHARY AVERY CHRISTENHOLZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/17/2022
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 BIESTERFIELD RD STE 110
ELK GROVE VILLAGE IL
60007-3393
US

IV. Provider business mailing address

901 BIESTERFIELD RD STE 110
ELK GROVE VILLAGE IL
60007-3393
US

V. Phone/Fax

Practice location:
  • Phone: 708-533-9667
  • Fax:
Mailing address:
  • Phone: 708-533-9667
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: