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General NPI Number Information
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NPI Number | 1952778987
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Entity Type | Organization
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Legal Business Name | ROOT ACUPUNCTURE AND HERBAL THERAPY INC
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Dates
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Enumeration Date | 08/25/2015
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Last Update Date | 08/16/2023
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Provider Practice Location Address
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Address Line | 3817 N PULASKI RD
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City | CHICAGO
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State | IL
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Zip | 60641-3141
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Country | US
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Telephone | 773-844-5709
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Fax |
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Provider Business Mailing Address
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Address Line | 3738 W SHAKESPEARE AVE
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City | CHICAGO
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State | IL
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Zip | 60647-3429
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Country | US
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Telephone | 773-844-5709
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. SONYA M SEIFERT
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Credential | L.AC.
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Telephone | 773-844-5709
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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 | 198.001084
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License Number State | IL
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