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General NPI Number Information
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NPI Number | 1376882977
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Entity Type | Organization
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Legal Business Name | ACUPUNCTURE & ORIENTAL MEDICINE
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Dates
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Enumeration Date | 02/04/2013
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Last Update Date | 02/04/2013
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Provider Practice Location Address
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Address Line | 3923 MERCY DR SUITE A
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City | MCHENRY
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State | IL
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Zip | 60050-3173
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Country | US
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Telephone | 815-363-1390
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Fax |
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Provider Business Mailing Address
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Address Line | 3923 MERCY DR SUITE A
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City | MCHENRY
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State | IL
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Zip | 60050-3173
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CO-OWNER
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Name | LISA TOMOLEONI
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Credential |
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Telephone | 815-363-1390
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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 | 198000809
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License Number State | IL
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