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General NPI Number Information
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NPI Number | 1770827040
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Entity Type | Organization
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Legal Business Name | HEALING ARTS OF ORIENTAL MEDICINE
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Dates
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Enumeration Date | 11/26/2012
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Last Update Date | 11/26/2012
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Provider Practice Location Address
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Address Line | 405 LAKE COOK RD STE 211
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City | DEERFIELD
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State | IL
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Zip | 60015-4993
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Country | US
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Telephone | 847-845-4090
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Fax |
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Provider Business Mailing Address
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Address Line | 405 LAKE COOK RD STE 211
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City | DEERFIELD
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State | IL
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Zip | 60015-4993
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Country | US
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Telephone | 847-845-4090
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | ANATOLIY PAK
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Credential | LAC
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Telephone | 847-845-4090
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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 | 198.000621
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License Number State | IL
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