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General NPI Number Information
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NPI Number | 1144653395
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Entity Type | Organization
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Legal Business Name | MODERN WELLNESS INC
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Dates
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Enumeration Date | 08/12/2013
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Last Update Date | 08/13/2013
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Provider Practice Location Address
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Address Line | 2835 N SHEFFIELD AVE STE 500
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City | CHICAGO
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State | IL
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Zip | 60657-5084
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Country | US
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Telephone | 773-525-6955
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Fax | 480-287-8538
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Provider Business Mailing Address
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Address Line | 2835 N SHEFFIELD AVE STE 500
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City | CHICAGO
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State | IL
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Zip | 60657-5084
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Country | US
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Telephone | 773-525-6955
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Fax | 480-287-8538
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Authorized Official
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Title or Position | OWNER OPERATOR
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Name | DR. ANTHONY PETER OLTEAN
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Credential | PH.D.
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Telephone | 773-620-2023
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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