Provider Demographics
NPI:1003316845
Name:EASTERN INTEGRATIVE HEALTH
Entity Type:Organization
Organization Name:EASTERN INTEGRATIVE HEALTH
Other - Org Name:HEALTH FROM EAST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ACUPUNCTURIST / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MITCHELL
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:312-345-3233
Mailing Address - Street 1:1534 W ESTES AVE # 3
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60626-2618
Mailing Address - Country:US
Mailing Address - Phone:317-345-3233
Mailing Address - Fax:312-345-3233
Practice Address - Street 1:1473 W IRVING PARK RD # IE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-2491
Practice Address - Country:US
Practice Address - Phone:312-345-3233
Practice Address - Fax:313-345-3233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-19
Last Update Date:2018-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL198.000830171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty