Provider Demographics
NPI:1093956229
Name:PRO-HOLISTIC INSTITUTE S.C.
Entity Type:Organization
Organization Name:PRO-HOLISTIC INSTITUTE S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAE
Authorized Official - Middle Name:M
Authorized Official - Last Name:BOUVIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:773-739-9017
Mailing Address - Street 1:2343 W MONTROSE AVE
Mailing Address - Street 2:UNIT A
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-1866
Mailing Address - Country:US
Mailing Address - Phone:773-739-9017
Mailing Address - Fax:
Practice Address - Street 1:2343 W MONTROSE AVE
Practice Address - Street 2:UNIT A
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-1866
Practice Address - Country:US
Practice Address - Phone:773-739-9017
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-18
Last Update Date:2009-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1891727145OtherRAE BOUVIN NPI
IL1750466991OtherEDGARDO VARGAS NPI
IL1750466991OtherEDGARDO VARGAS NPI