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General NPI Number Information
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NPI Number | 1093124620
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Entity Type | Organization
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Legal Business Name | WEST MEETS EAST ACUPUNCTURE LLC
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Dates
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Enumeration Date | 08/07/2014
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Last Update Date | 08/08/2014
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Provider Practice Location Address
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Address Line | 948 W HURON ST
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City | CHICAGO
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State | IL
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Zip | 60642-5914
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Country | US
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Telephone | 773-885-1819
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Fax |
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Provider Business Mailing Address
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Address Line | 939 W HURON ST UNIT 106
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City | CHICAGO
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State | IL
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Zip | 60642-5995
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Country | US
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Telephone | 773-885-1819
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Fax | 773-442-0672
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Authorized Official
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Title or Position | OWNER/MEMBER
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Name | KATHLEEN C HANOLD
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Credential | RN, MS. MSOM, LAC
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Telephone | 773-885-1819
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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 | 198.000975
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License Number State | IL
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