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General NPI Number Information
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NPI Number | 1902063266
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Entity Type | Organization
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Legal Business Name | HEALING INSTITUTE, LLC
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Dates
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Enumeration Date | 05/22/2008
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Last Update Date | 08/28/2008
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Provider Practice Location Address
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Address Line | 2416 BLOOMER DR
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City | ALTON
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State | IL
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Zip | 62002-4809
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Country | US
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Telephone | 618-465-9500
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Fax | 618-465-9502
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Provider Business Mailing Address
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Address Line | 2416 BLOOMER DR
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City | ALTON
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State | IL
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Zip | 62002-4809
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Country | US
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Telephone | 618-465-9500
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Fax | 618-465-9502
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Authorized Official
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Title or Position | OWNER
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Name | D'ANDRIENNE C JONES
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Credential | MD
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Telephone | 618-465-9500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 336-085886
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License Number State | IL
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