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General NPI Number Information
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NPI Number | 1427435775
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Entity Type | Organization
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Legal Business Name | CHICAGO ACUPUNCTURE CENTER LLC
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Dates
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Enumeration Date | 05/06/2015
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Last Update Date | 05/06/2015
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Provider Practice Location Address
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Address Line | 451 W HURON ST SUITE 609
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City | CHICAGO
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State | IL
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Zip | 60654-4567
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Country | US
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Telephone | 732-895-5216
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Fax |
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Provider Business Mailing Address
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Address Line | 451 W HURON ST UNIT 609
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City | CHICAGO
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State | IL
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Zip | 60654-4567
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Country | US
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Telephone | 732-895-5216
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JULIENNE J PARK
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Credential | L.AC.
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Telephone | 732-895-5216
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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 | 198.001247
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License Number State | IL
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