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General NPI Number Information
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NPI Number | 1457887648
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Entity Type | Organization
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Legal Business Name | JENNIFER L. FOCKLER, L.AC. LLC
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Dates
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Enumeration Date | 05/07/2017
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Last Update Date | 05/07/2017
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Provider Practice Location Address
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Address Line | 1030 N CLARK ST SUITE 610
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City | CHICAGO
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State | IL
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Zip | 60610-5467
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Country | US
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Telephone | 312-834-7522
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Fax |
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Provider Business Mailing Address
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Address Line | 1030 N CLARK ST SUITE 610
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City | CHICAGO
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State | IL
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Zip | 60610-5467
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Country | US
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Telephone | 312-834-7522
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JENNIFER LOUISE FOCKLER
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Credential | LAC
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Telephone | 312-834-7522
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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 | 198.001259
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License Number State | IL
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