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General NPI Number Information
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NPI Number | 1710526330
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Entity Type | Organization
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Legal Business Name | YIN AND TONIC, LLC
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Dates
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Enumeration Date | 12/30/2019
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Last Update Date | 04/26/2023
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Provider Practice Location Address
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Address Line | 4770 N LINCOLN AVE STE 212
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City | CHICAGO
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State | IL
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Zip | 60625-2092
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Country | US
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Telephone | 312-869-9654
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Fax |
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Provider Business Mailing Address
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Address Line | 4770 N LINCOLN AVE STE 212
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City | CHICAGO
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State | IL
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Zip | 60625-2092
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Country | US
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Telephone | 312-869-9654
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. MICHAEL OLIPHANT
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Credential | DACM
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Telephone | 312-869-9654
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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 |
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License Number State |
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