Provider Demographics
NPI:1124416060
Name:LAKE BLUFF ACUPUNCTURE, LLC
Entity Type:Organization
Organization Name:LAKE BLUFF ACUPUNCTURE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED ACUPUNCTURIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:HUI
Authorized Official - Middle Name:
Authorized Official - Last Name:DONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-533-3621
Mailing Address - Street 1:49 SHERWOOD TER
Mailing Address - Street 2:
Mailing Address - City:LAKE BLUFF
Mailing Address - State:IL
Mailing Address - Zip Code:60044-2231
Mailing Address - Country:US
Mailing Address - Phone:847-533-3621
Mailing Address - Fax:
Practice Address - Street 1:49 SHERWOOD TER
Practice Address - Street 2:
Practice Address - City:LAKE BLUFF
Practice Address - State:IL
Practice Address - Zip Code:60044-2231
Practice Address - Country:US
Practice Address - Phone:847-533-3621
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-30
Last Update Date:2014-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL198000962171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty