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General NPI Number Information
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NPI Number | 1396278883
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Entity Type | Organization
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Legal Business Name | OCIE BOOKER HEALTH AND WELLNESS CENTER OF CHICAGO
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Dates
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Enumeration Date | 04/11/2017
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Last Update Date | 04/11/2017
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Provider Practice Location Address
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Address Line | 10558 S MICHIGAN AVE
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City | CHICAGO
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State | IL
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Zip | 60628-2706
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Country | US
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Telephone | 773-704-2370
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Fax |
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Provider Business Mailing Address
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Address Line | 1163 E 159TH PL
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City | SOUTH HOLLAND
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State | IL
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Zip | 60473-1711
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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 | EXECUTIVE BOARD MEMBER
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Name | MR. JEFFREY HODGES
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Credential |
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Telephone | 773-704-2370
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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 |
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License Number State |
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