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General NPI Number Information
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NPI Number | 1992361919
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Entity Type | Organization
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Legal Business Name | WADE WELLNESS, INC.
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Dates
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Enumeration Date | 05/15/2019
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Last Update Date | 08/17/2020
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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 | 773-406-2091
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Fax | 312-971-1973
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Provider Business Mailing Address
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Address Line | 7238 W EVERELL AVE
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City | CHICAGO
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State | IL
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Zip | 60631-1933
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Country | US
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Telephone | 773-406-2091
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Fax |
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Authorized Official
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Title or Position | OWNER/ACUPUNCTURIST
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Name | JENNIFER WADE
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Credential | L.AC.
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Telephone | 773-406-2091
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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 |
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License Number State |
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