Healthcare Provider Details

I. General information

NPI: 1023431426
Provider Name (Legal Business Name): ADVANCED NATURAL HEALTH LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2014
Last Update Date: 11/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17W 580 BUTTERFIELD ROADD SUITE J
OAKBROOK TERRACE IL
60181
US

IV. Provider business mailing address

17W580 BUTTERFIELD ROADD SUITE J
OAKBROOK TERRACE IL
60181
US

V. Phone/Fax

Practice location:
  • Phone: 630-495-1855
  • Fax: 630-495-1856
Mailing address:
  • Phone: 630-495-1855
  • Fax: 630-495-1856

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038009954
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number198000604
License Number StateIL

VIII. Authorized Official

Name: SITIHIAMPHONE PHETCHAMPHONE
Title or Position: DOCTOR
Credential: DC
Phone: 630-495-1855