Healthcare Provider Details

I. General information

NPI: 1003660267
Provider Name (Legal Business Name): LEE FERRENBACH LAC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2024
Last Update Date: 04/15/2024
Certification Date: 04/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1585 N BARRINGTON RD STE 601
HOFFMAN ESTATES IL
60169-5020
US

IV. Provider business mailing address

1585 N BARRINGTON RD STE 601
HOFFMAN ESTATES IL
60169-5020
US

V. Phone/Fax

Practice location:
  • Phone: 847-490-8780
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number198001646
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: