MEDICARE: SERENITY HEALTH & WELLNESS, LTD

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	111N00000X	Chiropractor	038-010102	IL
2	111N00000X	Chiropractor	038-009394	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	01627924	OTHER	IL	BLUE CROSS PROVIDER ID #

General Provider Information

NPI Number	:	1588643431
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SERENITY HEALTH & WELLNESS, LTD

Provider Business Mailing Address
First Line	:	600 W FULTON ST
Second Line	:	SUITE 304
City	:	CHICAGO
State	:	IL
Zip	:	60661-1259
Country	:	US
Telephone Number	:	312-756-1778
Fax Number	:	312-756-1777

Provider Business Practice Location Address
First Line	:	600 W FULTON ST
Second Line	:	SUITE 304
City	:	CHICAGO
State	:	IL
Zip	:	60661-1259
Country	:	US
Telephone Number	:	312-756-1778
Fax Number	:	312-756-1777

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. KRISTINE LYN TOHTZ
Credential	:	DC
Telephone Number	:	312-756-1778

Provider Enumeration Date	:	01/10/2006
Last Update Date	:	02/27/2013

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Directions to “SERENITY HEALTH & WELLNESS, LTD ” Practice Location

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