Healthcare Provider Details

I. General information

NPI: 1437302429
Provider Name (Legal Business Name): SERENITY ACUPUNCTURE AND ORIENTAL MEDICINE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2008
Last Update Date: 11/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

503 MADISON ST
OAK PARK IL
60302-4435
US

IV. Provider business mailing address

503 MADISON ST
OAK PARK IL
60302-4435
US

V. Phone/Fax

Practice location:
  • Phone: 708-848-4626
  • Fax: 708-848-4757
Mailing address:
  • Phone: 708-848-4626
  • Fax: 708-848-4757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number198000419
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070008164
License Number StateIL

VIII. Authorized Official

Name: MRS. PATRICIA MILLER
Title or Position: OWNER
Credential: L.AC., PT
Phone: 708-848-4626