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General NPI Number Information
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NPI Number | 1548707987
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Entity Type | Organization
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Legal Business Name | EASTERN HEALING TRADITIONS
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Dates
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Enumeration Date | 01/24/2017
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Last Update Date | 01/24/2017
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Provider Practice Location Address
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Address Line | 34121 N US HIGHWAY 45 SUITE 218
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City | GRAYSLAKE
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State | IL
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Zip | 60030-1768
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Country | US
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Telephone | 224-541-0022
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Fax | 844-899-4225
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Provider Business Mailing Address
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Address Line | 34121 N US HIGHWAY 45 SUITE 218
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City | GRAYSLAKE
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State | IL
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Zip | 60030-1768
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Country | US
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Telephone | 224-541-0022
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Fax | 844-899-4225
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Authorized Official
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Title or Position | OWNER/ACUPUNCTURIST
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Name | MR. KUMARAVEL NATARAJAN
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Credential | LAC.
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Telephone | 224-541-0022
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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 | 198.00102
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License Number State | IL
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