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General NPI Number Information
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NPI Number | 1104584408
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Entity Type | Organization
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Legal Business Name | BODY WITHIN YOU
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Dates
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Enumeration Date | 12/03/2021
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Last Update Date | 12/16/2024
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Provider Practice Location Address
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Address Line | 917 W 18TH ST STE 302
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City | CHICAGO
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State | IL
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Zip | 60608-2400
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Country | US
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Telephone | 312-880-7004
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Fax |
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Provider Business Mailing Address
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Address Line | 1 E ERIE ST STE 525-3085
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City | CHICAGO
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State | IL
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Zip | 60611-2740
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Country | US
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Telephone | 872-205-6111
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. JAQUESSZIAN L DUKES
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Credential |
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Telephone | 872-237-2700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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