=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649698267
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RED ASPEN INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/01/2014
-----------------------------------------------------
Last Update Date | 04/01/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 512 W BURLINGTON AVE STE. 104
-----------------------------------------------------
City | LA GRANGE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60525-2221
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-288-2696
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 512 W BURLINGTON AVE STE. 104
-----------------------------------------------------
City | LA GRANGE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60525-2221
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | JAMES ZOTTI
-----------------------------------------------------
Credential | D.O
-----------------------------------------------------
Telephone | 708-288-2696
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | 198.000100
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------