Healthcare Provider Details

I. General information

NPI: 1114118544
Provider Name (Legal Business Name): HEALING TOUCH THERAPIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2007
Last Update Date: 06/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

660 DIAMOND POINTE DR
MUNDELEIN IL
60060-5602
US

IV. Provider business mailing address

660 DIAMOND POINTE DR
MUNDELEIN IL
60060-5602
US

V. Phone/Fax

Practice location:
  • Phone: 224-578-5175
  • Fax:
Mailing address:
  • Phone: 224-578-5175
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038-009481
License Number StateIL

VIII. Authorized Official

Name: DR. MARK WILLIAM SEVERANCE
Title or Position: OWNER
Credential: D.C.
Phone: 224-578-5175