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General NPI Number Information
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NPI Number | 1225416613
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Entity Type | Organization
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Legal Business Name | BIODYNAMIC HEALTH SYSTEMS
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Dates
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Enumeration Date | 05/18/2015
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Last Update Date | 05/22/2015
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Provider Practice Location Address
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Address Line | 4633 N WESTERN AVE
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City | CHICAGO
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State | IL
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Zip | 60625-2181
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Country | US
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Telephone | 773-789-7143
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Fax |
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Provider Business Mailing Address
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Address Line | 4605 N CLAREMONT AVE
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City | CHICAGO
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State | IL
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Zip | 60625-2014
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Country | US
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Telephone | 773-789-7143
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Fax |
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Authorized Official
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Title or Position | ACUPUNCTURE, CRANIOSACRAL, HERBS
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Name | SAMANTHA LOTTI
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Credential | L.AC., BCST
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Telephone | 773-789-7143
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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 | 198001246
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License Number State | IL
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