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NPI Code Detail

MEDICARE: CUSTOM HEALING AND WELLNESS MINISTRIES, NFP

MEDICARE: CUSTOM HEALING AND WELLNESS MINISTRIES, NFP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12081S0010XSports Medicine (Physical Medicine & Rehabilitation) Physician
22083P0901XPublic Health & General Preventive Medicine Physician
3208VP0000XPain Medicine Physician
41835N1003XNutrition Support Pharmacist
5208100000XPhysical Medicine & Rehabilitation Physician
6204C00000XSports Medicine (Neuromusculoskeletal Medicine) Physician
7204D00000XNeuromusculoskeletal Medicine & OMM Physician
82081N0008XNeuromuscular Medicine (Physical Medicine & Rehabilitation) Physician
92081P2900XPain Medicine (Physical Medicine & Rehabilitation) Physician
10133N00000XNutritionist
11171400000XHealth & Wellness Coach
12174400000XSpecialist
13174H00000XHealth Educator
14183500000XPharmacist
15172P00000XNaprapath

General Provider Information

NPI Number : 1366119398
Entity Type Code : Organization
Provider Name (Legal Business Name) : CUSTOM HEALING AND WELLNESS MINISTRIES, NFP
Provider Business Mailing Address
First Line : 320 E 21ST ST UNIT 405
Second Line :
City : CHICAGO
State : IL
Zip : 60616-4979
Country : US
Telephone Number : 312-872-7232
Fax Number :
Provider Business Practice Location Address
First Line : 3330 N MILWAUKEE AVE STE 1B
Second Line :
City : CHICAGO
State : IL
Zip : 60641-4001
Country : US
Telephone Number : 312-872-7232
Fax Number :
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : DR. SHANTE GRIGGS
Credential : PHARMD, DN
Telephone Number : 312-872-7232
Provider Enumeration Date : 08/26/2021
Last Update Date : 01/25/2023

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