MEDICARE: LIBERTYVILLE LONGEVITY AND LIGHT CENTER

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	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1972460848
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIBERTYVILLE LONGEVITY AND LIGHT CENTER

Provider Business Mailing Address
First Line	:	1880 W WINCHESTER RD STE 102
Second Line	:
City	:	LIBERTYVILLE
State	:	IL
Zip	:	60048-5321
Country	:	US
Telephone Number	:	847-717-8357
Fax Number	:

Provider Business Practice Location Address
First Line	:	1880 W WINCHESTER RD STE 102
Second Line	:
City	:	LIBERTYVILLE
State	:	IL
Zip	:	60048-5321
Country	:	US
Telephone Number	:	847-717-8357
Fax Number	:

Authorized Official
Title or Position	:	CERTIFIED HBOT TECH
Name	:	JUSTIN D SEYL
Credential	:	CERTIFIED HBOT TECH
Telephone Number	:	615-336-6506

Provider Enumeration Date	:	01/05/2026
Last Update Date	:	01/05/2026

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Directions to “LIBERTYVILLE LONGEVITY AND LIGHT CENTER ” Practice Location

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