MEDICARE: ELEMENTAL HEALING ARTS STUDIO, LLC

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	225700000X	Massage Therapist

General Provider Information

NPI Number	:	1386213593
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELEMENTAL HEALING ARTS STUDIO, LLC

Provider Business Mailing Address
First Line	:	3112 W FULLERTON AVE APT 1
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-8029
Country	:	US
Telephone Number	:	224-572-9704
Fax Number	:

Provider Business Practice Location Address
First Line	:	3112 W FULLERTON AVE APT 1
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-8029
Country	:	US
Telephone Number	:	224-572-9704
Fax Number	:

Authorized Official
Title or Position	:	MASSAGE THERAPIST
Name	:	SINGELI O ZAPARANIUK
Credential	:	LMT
Telephone Number	:	224-572-9704

Provider Enumeration Date	:	06/22/2021
Last Update Date	:	06/22/2021

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