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General NPI Number Information
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NPI Number | 1053569202
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Entity Type | Organization
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Legal Business Name | GREEN BAMBOO ACUPUNCTURE & ORIENTAL MEDICINE
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Dates
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Enumeration Date | 08/29/2008
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Last Update Date | 08/29/2008
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Provider Practice Location Address
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Address Line | 222 N COLUMBUS DR SUITE #305
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City | CHICAGO
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State | IL
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Zip | 60601-7810
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Country | US
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Telephone | 312-493-6459
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Fax |
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Provider Business Mailing Address
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Address Line | 222 N COLUMBUS DR SUITE #305
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City | CHICAGO
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State | IL
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Zip | 60601-7810
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Country | US
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Telephone | 312-493-6459
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Fax |
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Authorized Official
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Title or Position | PRACTITIONER/OWNER
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Name | CHRISTINA MARY LEE
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Credential | L.AC
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Telephone | 312-493-6459
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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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