Provider Demographics
NPI:1114517315
Name:TORIUMI, OLIVIA ANNE (DACM, LAC)
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:ANNE
Last Name:TORIUMI
Suffix:
Gender:F
Credentials:DACM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2052 N LINCOLN PARK W APT 1306
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-4705
Mailing Address - Country:US
Mailing Address - Phone:708-646-4025
Mailing Address - Fax:
Practice Address - Street 1:60 E DELAWARE PL STE 1425
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-1495
Practice Address - Country:US
Practice Address - Phone:312-741-3202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-21
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL198.001536171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist