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General NPI Number Information
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NPI Number | 1417197955
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Entity Type | Organization
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Legal Business Name | CHICAGO CENTER FOR PSYCHOPHYSICAL HEALING
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Dates
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Enumeration Date | 02/24/2009
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Last Update Date | 02/24/2009
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Provider Practice Location Address
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Address Line | 1622 W DEVON AVE
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City | CHICAGO
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State | IL
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Zip | 60660-1214
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Country | US
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Telephone | 773-764-0960
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Fax |
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Provider Business Mailing Address
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Address Line | 1622 W DEVON AVE
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City | CHICAGO
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State | IL
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Zip | 60660-1214
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Country | US
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Telephone | 773-764-0960
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. JOHN R NORTHAGE JR.
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Credential | L.AC
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Telephone | 773-764-0960
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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 | 198.000412
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 198.000302
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License Number State | IL
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