Provider Demographics
NPI:1093124620
Name:WEST MEETS EAST ACUPUNCTURE LLC
Entity Type:Organization
Organization Name:WEST MEETS EAST ACUPUNCTURE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:C
Authorized Official - Last Name:HANOLD
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MS MSOM, LAC
Authorized Official - Phone:773-885-1819
Mailing Address - Street 1:939 W HURON ST UNIT 106
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60642-5995
Mailing Address - Country:US
Mailing Address - Phone:773-885-1819
Mailing Address - Fax:773-442-0672
Practice Address - Street 1:948 W HURON ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60642-5914
Practice Address - Country:US
Practice Address - Phone:773-885-1819
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-07
Last Update Date:2014-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL198.000975171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty