MEDICARE: HEALING PARADISE ACUPUNCTURE

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
1	171100000X	Acupuncturist

General Provider Information

NPI Number	:	1376284067
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALING PARADISE ACUPUNCTURE

Provider Business Mailing Address
First Line	:	259 E RAND RD STE 107
Second Line	:
City	:	MOUNT PROSPECT
State	:	IL
Zip	:	60056-2184
Country	:	US
Telephone Number	:	224-307-4325
Fax Number	:	866-307-0289

Provider Business Practice Location Address
First Line	:	259 E RAND RD STE 107
Second Line	:
City	:	MOUNT PROSPECT
State	:	IL
Zip	:	60056-2184
Country	:	US
Telephone Number	:	224-307-4325
Fax Number	:	866-307-0289

Authorized Official
Title or Position	:	OWNER
Name	:	VICTORIA SOUS
Credential	:	LAC
Telephone Number	:	224-307-4325

Provider Enumeration Date	:	04/05/2022
Last Update Date	:	04/05/2022

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