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General NPI Number Information
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NPI Number | 1992275804
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Entity Type | Organization
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Legal Business Name | HERB & TAO ACUPUNCTURE AND WELLNESS
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Dates
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Enumeration Date | 12/04/2018
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Last Update Date | 07/20/2023
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Provider Practice Location Address
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Address Line | 47 W POLK ST STE M5
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City | CHICAGO
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State | IL
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Zip | 60605-2088
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Country | US
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Telephone | 312-971-7291
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Fax |
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Provider Business Mailing Address
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Address Line | 1700 E 56TH ST APT 2003
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City | CHICAGO
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State | IL
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Zip | 60637-5086
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | LLC MANAGER
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Name | JANELLE JEFFERSON
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Credential |
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Telephone | 708-679-4091
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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