=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043752934
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ART OF NATURAL HEALING LTD.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/09/2016
-----------------------------------------------------
Last Update Date | 11/09/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7773 LAKE ST
-----------------------------------------------------
City | RIVER FOREST
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60305-1736
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-366-8002
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7773 LAKE ST.
-----------------------------------------------------
City | RIVER FOREST
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60305
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-366-8002
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER PRESIDENT
-----------------------------------------------------
Name | KELSEY FERNANDEZ
-----------------------------------------------------
Credential | DIPL. O.M, L.AC., ND
-----------------------------------------------------
Telephone | 708-366-8002
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------