Healthcare Provider Details

I. General information

NPI: 1154673762
Provider Name (Legal Business Name): THRIVE INTEGRATIVE WELLNESS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2012
Last Update Date: 10/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 JACKSON AVE SUITE 235
NAPERVILLE IL
60540-5321
US

IV. Provider business mailing address

175 JACKSON AVE SUITE 235
NAPERVILLE IL
60540-5321
US

V. Phone/Fax

Practice location:
  • Phone: 630-313-2332
  • Fax: 630-518-4883
Mailing address:
  • Phone: 630-313-2332
  • Fax: 630-518-4883

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number198000819
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: MS. BRENDA MACNEIL
Title or Position: OWNER / ACUPUNCTURIST
Credential: L.AC.
Phone: 630-313-2332