Healthcare Provider Details

I. General information

NPI: 1679746739
Provider Name (Legal Business Name): LAUREL HEALTH CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2008
Last Update Date: 04/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3348 W 95TH ST
EVERGREEN PARK IL
60805-2236
US

IV. Provider business mailing address

122 HIDDENVIEW DR
WESTMONT IL
60559-2327
US

V. Phone/Fax

Practice location:
  • Phone: 708-422-1512
  • Fax: 708-422-1417
Mailing address:
  • Phone: 708-422-1512
  • Fax: 708-422-1417

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number StateIL

VIII. Authorized Official

Name: DR. LI-MEI KU
Title or Position: PRESIDENT
Credential: D.C.
Phone: 708-422-1512