Healthcare Provider Details

I. General information

NPI: 1417421645
Provider Name (Legal Business Name): XCEED ACUPUNCTURE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2019
Last Update Date: 01/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7627 LAKE ST STE 201
RIVER FOREST IL
60305-1878
US

IV. Provider business mailing address

7627 LAKE ST STE 201
RIVER FOREST IL
60305-1878
US

V. Phone/Fax

Practice location:
  • Phone: 708-366-8002
  • Fax:
Mailing address:
  • Phone: 708-366-8002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MS. KELSEY FERNANDEZ
Title or Position: PRESIDENT
Credential:
Phone: 708-769-9929