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General NPI Number Information
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NPI Number | 1477369296
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Entity Type | Organization
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Legal Business Name | CHICAGO HOLISTIC
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Dates
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Enumeration Date | 12/06/2024
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Last Update Date | 11/12/2025
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Provider Practice Location Address
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Address Line | 4361 N LINCOLN AVE
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City | CHICAGO
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State | IL
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Zip | 60618-2186
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Country | US
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Telephone | 312-478-8779
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Fax |
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Provider Business Mailing Address
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Address Line | 3526 N BOSWORTH AVE
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City | CHICAGO
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State | IL
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Zip | 60657-1364
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Country | US
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Telephone | 312-478-8779
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CHRISTOPHER AVILA
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Credential |
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Telephone | 312-478-8779
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number |
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License Number State |
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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 |
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License Number State |
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