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General NPI Number Information
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NPI Number | 1366731044
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Entity Type | Organization
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Legal Business Name | INNER HARMONY ACUPUNCTURE
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Dates
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Enumeration Date | 04/01/2011
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Last Update Date | 04/01/2011
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Provider Practice Location Address
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Address Line | 412 N LAKE ST
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City | AURORA
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State | IL
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Zip | 60506-4106
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Country | US
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Telephone | 630-605-9244
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Fax | 630-892-2535
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Provider Business Mailing Address
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Address Line | 412 N LAKE ST
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City | AURORA
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State | IL
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Zip | 60506-4106
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Country | US
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Telephone | 630-605-9244
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MAVIS A BATES
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Credential | L. AC.
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Telephone | 630-605-9244
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 198-000596
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License Number State | IL
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