Healthcare Provider Details

I. General information

NPI: 1619814654
Provider Name (Legal Business Name): EASTERN VITALITY ACUPUNCTURE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2026
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1218 S CRESCENT AVE
PARK RIDGE IL
60068-5317
US

IV. Provider business mailing address

1218 S CRESCENT AVE
PARK RIDGE IL
60068-5317
US

V. Phone/Fax

Practice location:
  • Phone: 773-800-1806
  • Fax:
Mailing address:
  • Phone: 773-800-1806
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name: CHRISTINA FRANCES DWYER
Title or Position: OWNER
Credential: L.AC.
Phone: 773-766-2017