Healthcare Provider Details

I. General information

NPI: 1366953101
Provider Name (Legal Business Name): HEALTH ELEMENTS INTEGRATIVE MEDICAL INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2017
Last Update Date: 10/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19740 GOVERNORS HWY STE 117
FLOSSMOOR IL
60422-2085
US

IV. Provider business mailing address

19740 GOVERNORS HWY STE 117
FLOSSMOOR IL
60422-2085
US

V. Phone/Fax

Practice location:
  • Phone: 708-914-4650
  • Fax:
Mailing address:
  • Phone: 708-914-4650
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QR1100X
TaxonomyResearch Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. PATRICIA ASHLEY WASHINGTON
Title or Position: BOARD CHAIRMAN
Credential: DAOM, PHD, LAC
Phone: 708-914-4650