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General NPI Number Information
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NPI Number | 1548654924
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Entity Type | Organization
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Legal Business Name | REVOLUTION ACUPUNCTURE & HERBS
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Dates
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Enumeration Date | 03/24/2015
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Last Update Date | 05/28/2019
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Provider Practice Location Address
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Address Line | 331 N WOOD DALE RD
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City | WOOD DALE
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State | IL
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Zip | 60191-1531
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Country | US
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Telephone | 630-422-5232
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Fax | 630-635-6689
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Provider Business Mailing Address
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Address Line | 331 N WOOD DALE RD
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City | WOOD DALE
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State | IL
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Zip | 60191-1531
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Country | US
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Telephone | 630-422-5232
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Fax | 630-635-6689
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Authorized Official
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Title or Position | OWNER/LICENSED ACUPUNCTURIST
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Name | MR. NANN LANG
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Credential | LAC
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Telephone | 630-422-5232
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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 | 198001197
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License Number State | IL
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