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General NPI Number Information
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NPI Number | 1982197158
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Entity Type | Organization
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Legal Business Name | HOL HEALTH STUDIO LLC
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Dates
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Enumeration Date | 06/12/2018
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Last Update Date | 02/08/2019
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Provider Practice Location Address
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Address Line | 1157 W 18TH ST
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City | CHICAGO
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State | IL
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Zip | 60608-2387
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Country | US
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Telephone | 630-242-0743
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Fax |
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Provider Business Mailing Address
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Address Line | 1157 W 18TH ST
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City | CHICAGO
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State | IL
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Zip | 60608-2387
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Country | US
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Telephone | 312-344-1632
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Fax |
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Authorized Official
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Title or Position | PROVIDER
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Name | PENG PHETCHAMPHONE
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Credential | DC
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Telephone | 312-344-1632
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | 038010281
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License Number State | IL
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