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General NPI Number Information
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NPI Number | 1205482973
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Entity Type | Organization
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Legal Business Name | MERIDIAN PEAK
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Dates
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Enumeration Date | 08/17/2019
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Last Update Date | 08/17/2019
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Provider Practice Location Address
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Address Line | 4300 COMMERCE CT STE 318
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City | LISLE
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State | IL
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Zip | 60532-3698
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Country | US
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Telephone | 630-686-2626
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Fax | 630-626-4463
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Provider Business Mailing Address
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Address Line | 4300 COMMERCE CT STE 318
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City | LISLE
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State | IL
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Zip | 60532-3698
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Country | US
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Telephone | 630-686-2626
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Fax | 630-626-4463
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Authorized Official
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Title or Position | DIRECTOR/OWNER
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Name | MR. MARC HOLM
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Credential |
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Telephone | 630-686-2626
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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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