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General NPI Number Information
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NPI Number | 1629361969
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Entity Type | Organization
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Legal Business Name | ACUPUNCTURE HEALTH CENTER
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Dates
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Enumeration Date | 05/19/2011
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Last Update Date | 05/19/2011
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Provider Practice Location Address
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Address Line | 3301 RESOURCE PKWY 5
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City | DEKALB
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State | IL
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Zip | 60115-5334
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Country | US
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Telephone | 815-895-1461
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Fax | 866-808-1391
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Provider Business Mailing Address
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Address Line | 3301 RESOURCE PKWY 5
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City | DEKALB
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State | IL
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Zip | 60115-5334
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Country | US
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Telephone | 815-895-1461
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Fax | 866-808-1391
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Authorized Official
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Title or Position | LICENSED ACUPUNCTURIST
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Name | MS. PATRICIA A FAIVRE
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Credential | L.AC
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Telephone | 815-895-1461
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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 | 198000020
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License Number State | IL
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