=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306573282
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MADVITALITY ACUPUNCTURE & WELLNESS PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/02/2022
-----------------------------------------------------
Last Update Date | 10/31/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3166 N LINCOLN AVE STE 405
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60657-3119
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 260-232-2063
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3166 N LINCOLN AVE STE 405
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60657-3119
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 260-232-2063
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DOCTOR OF ACUPUNCTURE
-----------------------------------------------------
Name | DR. MADALEN BROOKS
-----------------------------------------------------
Credential | DACM, LAC.
-----------------------------------------------------
Telephone | 260-232-2063
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------