Healthcare Provider Details

I. General information

NPI: 1568627552
Provider Name (Legal Business Name): ANTARES INSTITUTE OF INTEGRATIVE HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2008
Last Update Date: 07/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

545 PLAINFIELD RD SUITE E
WILLOWBROOK IL
60527-7600
US

IV. Provider business mailing address

545 PLAINFIELD RD SUITE E
WILLOWBROOK IL
60527-7600
US

V. Phone/Fax

Practice location:
  • Phone: 630-321-2296
  • Fax:
Mailing address:
  • Phone: 630-321-2296
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070008189
License Number StateIL

VIII. Authorized Official

Name: MRS. ELIZABETH MARGARET HENLEY
Title or Position: OWNER
Credential: PT
Phone: 630-321-2296