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General NPI Number Information
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NPI Number | 1669778742
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Entity Type | Individual
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Provider Name | MAVIS A. BATES L. AC.
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Gender | Female
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Dates
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Enumeration Date | 02/07/2011
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Last Update Date | 02/07/2011
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Provider Practice Location Address
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Address Line | 412 N LAKE ST
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City | AURORA
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State | IL
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Zip | 60506-4106
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Country | US
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Telephone | 630-605-9244
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Fax | 630-892-2535
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Provider Business Mailing Address
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Address Line | 412 N LAKE ST
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City | AURORA
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State | IL
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Zip | 60506-4106
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Country | US
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Telephone | 630-605-9244
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Fax | 630-892-2535
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 198-000596
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License Number State | IL
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