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General NPI Number Information
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NPI Number | 1487722666
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Entity Type | Organization
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Legal Business Name | WHOLEHEALTH CHICAGO-3
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Dates
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Enumeration Date | 12/04/2006
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Last Update Date | 07/15/2021
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Provider Practice Location Address
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Address Line | 2522 N LINCOLN AVE
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City | CHICAGO
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State | IL
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Zip | 60614-2352
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Country | US
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Telephone | 773-296-6700
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Fax | 773-296-1131
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Provider Business Mailing Address
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Address Line | 2565 N CLYBOURN AVE
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City | CHICAGO
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State | IL
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Zip | 60614-3052
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Country | US
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Telephone | 773-296-6700
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Fax | 773-296-1131
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Authorized Official
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Title or Position | SECRETARY
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Name | DAVID KEITH EDELBERG
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Credential | MD
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Telephone | 773-296-6700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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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 | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 133N00000X
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Taxonomy Name | Nutritionist
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License Number |
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License Number State |
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Taxonomy #4
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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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Taxonomy #5
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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