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General NPI Number Information
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NPI Number | 1801616370
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Entity Type | Individual
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Provider Name | HENRY VACHON
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Gender | Male
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Dates
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Enumeration Date | 10/10/2024
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Last Update Date | 10/10/2024
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Provider Practice Location Address
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Address Line | 1969 W OGDEN AVE
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City | CHICAGO
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State | IL
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Zip | 60612-3765
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Country | US
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Telephone | 312-864-3600
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Fax |
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Provider Business Mailing Address
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Address Line | 336 W WELLINGTON AVE APT 1202
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City | CHICAGO
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State | IL
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Zip | 60657-5609
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Country | US
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Telephone | 773-882-3650
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Fax |
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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 | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 070.028568
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License Number State | IL
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