Healthcare Provider Details

I. General information

NPI: 1063871747
Provider Name (Legal Business Name): BSMC-AOM INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2016
Last Update Date: 02/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 LAKE ST 210
OAK PARK IL
60301-1046
US

IV. Provider business mailing address

1101 LAKE ST 210
OAK PARK IL
60301-1046
US

V. Phone/Fax

Practice location:
  • Phone: 708-848-1277
  • Fax: 708-848-8234
Mailing address:
  • Phone: 708-848-1277
  • Fax: 708-848-8234

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code173C00000X
TaxonomyReflexologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number227004153
License Number StateIL

VIII. Authorized Official

Name: ROBERT WARWICK
Title or Position: PRESIDENT
Credential: LMT,DD
Phone: 708-848-1277