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General NPI Number Information
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NPI Number | 1013716539
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Entity Type | Organization
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Legal Business Name | RED EARTH ACUPUNCTURE, LLC
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Dates
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Enumeration Date | 03/08/2025
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Last Update Date | 03/08/2025
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Provider Practice Location Address
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Address Line | 2341 W 25TH ST
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City | CHICAGO
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State | IL
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Zip | 60608-4910
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Country | US
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Telephone | 312-394-9214
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Fax |
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Provider Business Mailing Address
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Address Line | 2047 W 23RD ST APT 1R
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City | CHICAGO
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State | IL
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Zip | 60608-0503
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Country | US
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Telephone | 312-394-9214
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Fax |
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Authorized Official
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Title or Position | ACUPUNCTURIST
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Name | SYLVIA M GONZALEZ
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Credential | LAC
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Telephone | 312-394-9214
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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 |
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License Number State |
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