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General NPI Number Information
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NPI Number | 1003316845
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Entity Type | Organization
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Legal Business Name | EASTERN INTEGRATIVE HEALTH
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Dates
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Enumeration Date | 02/19/2018
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Last Update Date | 02/19/2018
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Provider Practice Location Address
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Address Line | 1473 W IRVING PARK RD # IE
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City | CHICAGO
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State | IL
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Zip | 60613-2491
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Country | US
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Telephone | 312-345-3233
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Fax | 313-345-3233
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Provider Business Mailing Address
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Address Line | 1534 W ESTES AVE # 3
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City | CHICAGO
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State | IL
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Zip | 60626-2618
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Country | US
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Telephone | 317-345-3233
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Fax | 312-345-3233
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Authorized Official
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Title or Position | ACUPUNCTURIST / OWNER
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Name | MITCHELL HARRIS
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Credential | LAC
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Telephone | 312-345-3233
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 198.000830
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License Number State | IL
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