Healthcare Provider Details

I. General information

NPI: 1962882704
Provider Name (Legal Business Name): IXCHEL Z MUHLBERGER L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2015
Last Update Date: 06/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1818 DEMPSTER ST
EVANSTON IL
60202-1003
US

IV. Provider business mailing address

6342 N MOZART ST
CHICAGO IL
60659-1524
US

V. Phone/Fax

Practice location:
  • Phone: 847-868-0528
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number198000970
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: