=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548443088
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PROPER BALANCE HEALTHCARE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/06/2007
-----------------------------------------------------
Last Update Date | 01/18/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 800 S WELLS ST STE 150
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60607-4529
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 312-339-5571
-----------------------------------------------------
Fax | 312-280-1570
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 800 S WELLS ST STE 150
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60607-4529
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 312-339-5571
-----------------------------------------------------
Fax | 312-280-1570
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. CHRISTINA CREEVY
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 312-339-5571
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------